all right so let's do that today so today I'm going to talk about the heart let me finish today we can explain where the hearts located how it is protected to better be protected we look at the four chambers of the heart the internal structure of the heart we also look at the blood vessels that attach to the heart and we look at how the heart is in two pumps in one situation how it pumps the blood through the lungs and then through the rest of the bar pulmonary means lungs you see there were pulmonary that means lungs we talk about the flow of the heart the blood the blood and the flow of the blood through the heart the blood flows in one direction it doesn't fall back it just goes one way so we can go step by step by step so that's okay we'll have a little discussion about heart valves and then we go into the electricity of the Lord how the heart gets triggered to contract because heart contracts like sixty to a hundred times a minute or more and it's got to be pretty coordinated how it does that so we'll talk about the electro cardiogram as well and then we get into the contraction relaxation you might have her to turn systole and diastole before since the Lea has made a horrible contracts diastole is when the heart relaxes we take a ball pressure we take a two two numbers a higher number in the lower number that responds to those to the contraction the relaxation then a little make sure we do a little bit of math in here also so we have a formula of how - how measure how much blood does a heart pump in one minute and lastly here the heart supplies itself with plot we'll have to look at that Anatomy to a little bit so first of our located it's positioned in the chest between the vertebral column in the back the spine in the back the bones posteriorly and the sternum the chest plate in the front the anteriorly laterally it's protected by the lungs on the outside so you see that here pushing on the bottom side we have two diaphragm the muscle that separates the whole thoracic to the abdominal cavity and I always think of that like the thoracic cavity is mostly air and if Donald called cavity there's no way it is all liquids and solid stuff and so up here we kind of breathe open that needle down also his diaphragm and so that the air goes in and out and down here we haven't rehab that core we talked about the core you know where we can compress that link with it then it's really nice and solid history so that's one of the differences between the thoracic and abdominal pelvic cavity the apex of the heart is touching the front of the chest wall at an angle so you look at the heart it sort of lays in the body like that so the bottom part here is known as the apex and it sort of holes for were dangling down a little bit so it goes towards the chest wall and the base of the heart that's the top portion of the heart when you can sort of sort of visualize is a little bit of a triangle here it's tipping stickers at the bottom at the top is much more broad and so that's called the apex because of the the basis on top and that is more on superior posterior and that the base is where the great vessels come out so these here that you can see here this red stuff and this blue stuff here those are called the great vessels there are these things over here and sort of you can almost visualize that the heart is hanging down on those that sort of suspended in your chest don't you like I start on the lining thing I don't makes it easy for me to teach it but of course that was the afterthought it was more like happy to make it as easy for you guys as possible because this is a very interesting concept it's brilliant but it's a little complicated understand protection of the heart the heart is protected in this fashion but also the lungs and a lot of the abdominal viscera the abdominal organs are also protected in this fashion is this sort of membrane system and that membrane system is known as the serous membrane system and what happens in that system is organs are suspended with within two membranes or that whole membrane system like we take a fist and push it into a balloon and so what we're going to get begin again created in a closed space between the serous membranes attaching to the organ so what were you going to get is we we have we have when we put a face to the balloon we have one part of the balloon that's on the outside and then another part of the balloon it's sort of like right on the on the fist of the inside and so if you actually were to take you know you were to just cut through here of course it will pop but if you take the heart you can talk through here or you could cut through here and you end up having something that looks like it's two membranes because you don't know that this one balloon you don't know it's one thing so it has a membrane heads on the organ on the fist or the heart here and then a membrane has towards the outside towards the wall but it's not two membrane it's one membrane that is connected on top on one side and then on the other side also and so we're going to create a space on the inside that's enclosed there's no no connection to the outside with what's going on sign here and so inside of here we can see create some fluid so we got a little bit of liquid like water but a little bit more oily than water so it's a little glitchy and so then the heart pumps and it moves and contracts it can move inside that liquid and it sort of like left alone by that it doesn't have to be pushing everybody all over the place so that's that system it's really really brilliant and so organs are suspended within the serous membranes membranes as if we push the fist into a balloon creating an enclosed space between them the serous membranes so that's that in-between here and one part of the memory is attached to the organ and we call that the visceral part of the membrane the visceral layer when you see that word miss we see that with viscera you're always thinking internal organ type of stuff when you think internal organs you're thinking heart lungs God that kind of stuff you don't think muscles and bones that's and and you don't think brain you're thinking God chest and cop stuff so whenever you see this sorrow you got something wrong with those orders so the membrane portion that's right around that organ is called the visceral layer of that membrane and then the one that's on the outside it's attached to the cavity should've taken that's known as the parietal layer parietal means on the outside of the parietal bone is called as the outside so that means the wall so this is really cool because well we have HEPA delial cells remember epithelial cells they see they do stuff yes yeah it gets complicated I know I mean it's telling me don't open all you know hard day know the hard we don't well they incredible with a heart like compared to water or you know the brain I mean the heart spike quite simple that way in respect to understanding how the mechanics working out it's still it's incredible so that so they are incredible with hearts especially they look like children's stuff submitting small so we have these epithelial cells they secrete fluid they secrete that serous fluid to cause the serious flu that food that's inside the space and so that what that fluid does it helps reduce friction do remove with it that's good what it also does though is really cool in the lungs its suctions belongs to the chest wall we're going to talk about that when you talk about respiration that's really fantastic because lungs lungs are like fluffy puffy tea they're like you know air air sacs they don't think edges inflate deflate on their own they're no muscles they're know like so what happens is the walls are attached to the chest wall on to the diaphragm through this system because we can create a suction of this membrane of this membrane either one and when the chest wall moves and the diaphragm moves down the halls follow it they get pulled with it and that creates a suction through the miles and through the nose that's inhalation and an exhalation when they push it back up so that's really neat and then the last thing we want to talk here is the name of these membranes so we have the inner layers known as the visceral layer the outer layer is known as the parietal layer and then it depends on which organs are they in so that the hard stuff we call that pericardium peri means around Perry means around and card you meet heart so membrane around the heart in the chest it's known as the plural maybe your work before somebody having clearly see this way do Rishi probably know maybe this way but anyway that's an inflammation of this membrane in the lungs but you can only imagine if this met this fluid in here is not really secreted and then the offices fluid supposed to reduce friction there's normally a lot food and suction it so you've got this function in both of those that must hurt like crazy mean to try to inhale if there's no fluid in here not more intuitive so that's yeah when you look at the pathology always looking at the names you're always trying to figure out what would that make me like you see a thing called an is you know it's an inflammation whatever I this is an inflammation of that thing all right so that's the protection linings around the lungs and around the heart of course because we're talking about the heart right now so the heart's enclosed the pericardial sac and the outer layer of that sac is known as the fibrous pericardium watch out this visceral parietal stuff is common right back here - so the fibrous pericardium is right here on the outside it's right here on the outside fibrous pericardium is right here on the outside and it enters its dense connective tissue and all that down here so it anchors the heart to its surroundings and then we have a second layer to that pair to that very cordial to that heart wall the pericardial sac then either later and that inner layer becomes the parietal pericardium and then here you see how to connect because the next layer on the inside will then be the visceral pericardium right here and the visceral pericardium is also known as the epicardium I know Jesus can't they keep their legs straight but it's just kind of slowed down with the names because even though there's a lot of these names but at least you got a ball home base you can always look em up epi means around on top of some so FP cardian is the membrane on top of the heart as a word so @b will say every means on top terry means around so that's the bigger envelope on top around the whole thing a pericardial achieve their Carden comes back over and over and then you heard before write the heart is a muscle the heart muscle we talked a little bit about that not that much and the heart also the name for that is Mario carbon that's the red stuff that's the richer and remember my know what is my refer to muscle tissue that was in the chapter when we started Muslim is are called miss you all that those are mostly terms so my cardio means or muscle see if they would have written in English then we go to China we got our a whole different world but this time you just go around the overall is always the same where it's perfect and I probably try to write it in English too so we can really do and then on the inside we have one more membrane that lines the inside of the heart chambers an excellent as the endocardium an endo means insult yeah you almost want to have like flashcards with these you know maybe things because the prefix is taken back over know the soft pitches to so it's a lot of it is just putting names together so we have the visceral pericardium in the heart itself is the epicardium that's right here then beneath them is the mild harder that's that muscle which is the actual muscle of the heart when it contracts pockets pump through its James into vessels that deliver it to all the body cells if the myocardium is starved of oxygen and gets damaged we have a heart attack so that so known is a myocardial infarction an mi that's a very bigger problem we have in our world in the Western roads generally and the endocardium wants the heart chamber themselves and is continuous with the inner lining of the blood vessels and we're going to talk about blood vessels like way after the breaking you remember nothing about this I hope you forget this but inside the blood as they don't call it endocardium they also don't call it end of war vessels they call it endothelium th this is all preferable for the brain you know just kidding dad we have blood vessels yeah we have a lot of so the heart you know the cardiovascular system is a heart that pumps the blood that it pumps the blood through all these vessels in the body and then delivers liquid things to the to the tissues and gas like oxygen that's the main thing oxygen and glucose and of course a lot of smaller things and then it takes the waste and bring it back and and delivers it to the organs that can excrete it too long for this carbon dioxide etc etc the kidneys arteries are maybe heard of the word arteries yeah so arteries are vessels that attach no they don't all attached to the heart but they're vessels they carry the blood and may from the heart so all the blood travels through the body in one direction or traveled through the vessels in one direction so arteries are vessels that carry the blood away from the heart veins or vessels they carry the blood that guide I should say guide the blood from the body back to the heart so those are veins the rules and so now we have masses that come from the heart when offenses they told to the heart and then we got vessels in between they're connected the origin today and those are capillaries capillaries are we treated them throughout the body they are leaking so that blood seeps into tissues to exchange substances like oxygen and nutrients so all the reason veins are not leaking blocked out from within them into the tissue they're just channels they're freeways but we need the oxygen you go to the cells of the tissue otherwise it's not going to do any good same with the nutrients if the glucose doesn't get to the muscle cell is not going to do any ATP it's not gonna make energy and so for that we have capillaries and capillaries because of that are lifting so they see the fluid from the inside of these Kapler seeps into the tissues on the artery side and then on the venous side and pulls it back into the system also don't facts if you have lymphatic stuff with the lymphatics lymphatic drainage or so that's also help that's helping the system we want to talk about that on Monday in a long time so those are those are the main three types of vessels that we're gonna study we're not going to do too many native ones because we just came from naming all these muscles of a little lame doubt and that was tracked so we don't leave that to the next class but I want to just give you the general concept of how the ball passes working a lot of the names of all bases are like where they go through like brachial subclavian and the owner and the radio we already learned a lot of those names you will make up where they are when you learn identifying them let me open the heart off on the inside inside the heart we have four chambers we have two chambers on top and we have two chambers on the board the top chambers are known as the atrium so we we have the hearts like that in the body so the right side when you look at me that's your left that's a website for you but it's the way we look in an atom is we're looking at from perspective of the patient so no matter what part you look in the manner which direction looking at the heart this is always going to be the right side of the heart because in the patient it's gone away like that it's not going to turn around inside the page so the top two chambers of our atrium the bottom two chambers are many triples the top our four chambers a means for chamber or receiving chamber what's a for hall in that availability a true and anna ventricle is in it also known as an injection chamber because when we squeeze this one that's when the wall travels through the body the AGR the chambers where the wall comes in sort of trickles in and then the ventricles is waiting contracts and what gets pumped into the lungs or to the rest of the body and when he goes to the walls you know that as the pulmonary circuit whenever you see the word pulmonary you're thinking lungs and then and that happens actually that wall comes to the right side here that goes up into the that goes into the lungs here that goes to the lungs to Long's and then on the other side we have well when the blood thing comes back from the lungs back to the other side of the heart the other side palms to blow to the whole body a whole system so they call that the systemic circuit so when the block gets pump actually through here that goes to the body so that's the systemic that goes yes and the left ventricle pumps ply goes behind this podium because behind you pumps blood to the body that includes the brain the arms to let everything else or let alone it actually also includes well no no it does it includes the lungs to in terms of feeding the lung tissue but it doesn't feed it does the pulmonary circuit is here so the block can pick up oxygen from dogs so that's what that is I know it's getting more complex huh pulmonary surrogate systemic circuit atria ventricle yes yeah that's well you know we're gonna have this main vessel that goes extra from here then it goes down through the abdomen and our vessels come off of it they feed the different organs then at the end it goes into the legs and then from there comes back with veins so the orders go out the veins come back between the right and the left part of the heart we have a wall a heart wall and they call that a sector the mall school apart and so it's a muscle that it's while it's small skew layer that separates the left from the right side so the right atria on the Left HR / intern atrial septum they call that the septum means wall and ventricles are divided by interventricular septum septum is a wall between so we have this bottom part of the heart in the top part on our right so we actually look it's interesting when you look at the heart let me see if I find the skeleton the skeleton I don't think I have a picture of this yeah but if you kind of see here this thing around here this here on top is the atrium area and below is the ventricular area so the heart you can sort of divide between the top of the bottom and there's like a lot of tissue then some that's the white tissue in the muscle that's the fascial that that since it is plated in circles it like the crown almost like it goes around it and it makes it's almost like a skeleton but it's fashio it's not bone but it makes it sturdy and so in that plane you have been from day if it top part of the heart of the bottom part of the heart and then you're also needing to have a connection a separation between the left and the right part of all and that's done by a septum they call it the septum as a wall choose that turn and on top where we have that between the two atria we call it in turn atrial in between is inter atrial septum and words between the ventricles we call an intervention Keillor septum intermediate between them so septum is wall inter intra interventricular again all of this is terminology just hearing about this a few times and it starts to roll more off the tongue because it's it's verb creations it's playing Legos with words so then that brings me to the topic of heart balance and the heart has two sets of two valves that guard both the entrance and the exit of both ventricles to prevent backflow so I said the blood travels in one direction so the world from the systemic circuit comes up from the body comes from below and above the body and enters into the right atrium and from there that blood will follow flow down into the right ventricle and then from there that what goes into what we're gonna learn as the pulmonary trunk again pulmonary means lungs so when you read pulmonary you're thinking it's going to the lungs or coming from below and so then and that flow of blood some of that is gravity like the way that the block goes from the pages of the ventricle some of that is gravity but you're not going to add gravity eject that block outside of the ventricles and so when a ventricle contracts here that blob has two holes you can go through it can go either blunt way to the pulmonary trunk or you can go back to the atrium on the right side but would that make sense that's where the ball came from we don't want it to go backwards we're going to go forward and so now what we have here we have here about and you see this valve on your model here or if you don't have it the valve here is right here that white stuff it's simple eyes in the battle and that valve is known as the atrial ventricular valve because it lies between the atrium and the ventricle and then the heart muscle contracts that valve closes up and closes this here and makes a door that shots that the block cannot go backwards it cannot go backwards because of that value and this map is very interesting the valve is is is or you can see that actually in here the valve this is one of those valves between the age of the ventricle it has some tendons like these little strings on it they call heartstrings or cord of tendon a I know tenderness course and then from there from the cord of 10 today in those cords anchor into a little muscle thing known as the papillary muscle right here papillary muscle I think is lower down over here popular and also and then below that we have meaty parts of them also which also have a purpose in the heart but we're not going to talk about that right now but when the heart muscle contracts down here when the muscle contracts it it shortens so the heart muscle contracting it will shorten this whole heart a little bit and then these tendons they don't shorten so those flaps get pushed up a little bit into a place where they're closing this this hole between the ventricle and atrium so you can think it's kind of like a sail that's attached to a string and the wind pushes it you want to let it go and you don't want to let it go too much you have that tension it's like that we want to keep these flaps these these white flappy things here these leaves they call them actually we want to keep them in place between the entry of the ventricle between the ventricle nature so we do not have any backflow of blood and harbor trackers well that's one set that was a little bit of our explanation you understand that a little bit yeah because then we got the order said to valves and the other sets of owls are known as descending lunar balance and that's the semilunar means half moon and when you look up from the heart these valves are these valves here so this is actually a shop where you're looking from the HR basically downward into the ventricle so you caught the top of the heart off and you're looking down so you're seeing these are the HIV tricular mouse sometimes they call them a B vows ad valves also atrial ventricular valve or since you know these are Animists and they have nothing else to do other than naming things to grief also a little bit more the one on the right side they called tricuspid valve and one on the left side they call mitral or even as if the rent by cuspid mouth the reason why they called cuspid thrive backed off with a cost is one of those leaves that one of those flaps that you can sort of see the flaps down and then is attached to the strings so if you look really really close on the right side you have three flaps and on the left side you only have two flaps and so that's why they call the logs where there's three flaps try try these three and alert there's two flaps they only call it buy because buys two yes you mean as a as an anomaly you know I don't know I mean you if if you don't have paint you know if if the whole here eater done closed fully or is not opening for what you're gonna get turbulence in the body gonna burn and so I would assume since the design is sort of four three flaps if you have two flaps which is gonna remember but I don't know if that's a very common occurrence or if that isn't occurred then there's one more name mitral valve and now you know that this stuff that balloon it in Italy or so because as Italy or at least for the Catholic churches because the bishops mitre is like two flaps coming together on top so it's a tooth flap thing and so that comes from the bishops mitre the Hat of the vigil I don't care about that so those are these valves but then the other walk down here those are the semilunar valves and the reason why they called semilunar valves is because to the anatomist was all a wide in it that looks like a Halfmoon looking down at them like a little bit of a Halfmoon I mean if we're also have looks you know something like you know the moon is half or so something like that but for damn it looks like that so they call these the same lunar valves and those are valves that guard right here the exit of the ventricles so those flat open to the upwards they open upwards and many of what many ventures contract what happens on the inside is fluid gets really powerful strong and wants to go somewhere because this contracts for me and it's gonna go where its opening doors and it's gonna go through this because it's kind of push this valve open and the block will eject into the pulmonary trunk or here this is going to be called today or go the one that comes from the left side so on the model it's going to push the body door so here on the right side you know this vessel that's the pulmonary trunk or on the left side you can see it behind the bishops flap where you see those white things on top that's where we have it going to the aorta that's this vessel of then from that goes to the whole body so as to AV valves hold close to let the bottle go back the settlor valves are pushed open for the block to get through a knee forward and then and that happens when the heart muscle contracts and then the heart muscle then relaxes and you have a little one that still goes up gravity will fall back down and now it doesn't have to fall all the way down to the ventricle again it will only fall back down to these flaps and then the blood is held up on these flaps and fills up a little bit and then that puts a little weight on the flap so the next time the heart contracted has to push hard to force it open and that force increases to force of the blood pressure getting out of the heart and that helps partly why we can have Jake it well then forcefully out of the heart and so there's dynamics vascular dynamics that get created with these valves but for us most important is that the semilunar valves are at the exit of the ventricles and are pushed open when the heart is contracting the one that guards on the right side that is for the bluff that goes to the lungs we call that the pulmonary semilunar valve or pulmonary valve and the other one that course right on the other side of the left ventricle that guards to me my order we call that the aortic semilunar valve or the aortic valve all right so that's for after that make sense to having all these things you want halfway what we're going to do it you can do questions for after the break but let that issue something there's a little break right and then we can torture it again let me come back so now let's put it together a little bit so now we're going to have to swap for going through the whole thing and by the way we're gonna get heart sounds have you heard of your hearts that they can sound yet ever yeah the heart sounds are when the valves close but let's talk a little bit more about the pulmonary and systemic circuit so the right side of the heart concerns itself with pumping ball to the lungs where option is picked up for gaseous waste which is co2 is disposed do you know deep oxygenated blood so that's what with that oxygen that is blue blood in terms of our blood thing so in the heart in these models it's pretty good the top stuff is color-coded more or less so blue means deoxygenated red means oxygenated so you have to be very careful that you think red means artery no and blue means millions no most places in the body yes but not in your heart because in the heart the definition is always the same definition but in the heart it makes a difference when you have the vessel that is deoxygenated blood going from the harm to the logs that's still an artery even if it's blue and then as we get back we haven't done that yet we get back from the lungs these vessels back here are red because they have oxygen but these are veins so we have to be careful with that we have to keep the definition of arteries and veins in the head most places that works the bluest veins the red is arteries but not in the heart they're blue means what blue always means deoxygenated blood and red means oxygenate apart little bit more red when we look at look at it so the outside apart from the body dishes and just the right atrium we talked a little bit about that before but that's right here right eight trees right there via the superior overlook new terms beyond the superior and inferior vena cava these paint vessels here coming from above and below getting the blood into the right no that's it the right atrium those are known as the vena kalyan super inferior vena cava on the heart model there right here that inferior right here and the superior is right here bringing God into this problem major on the right side to change and so then the tricuspid valve open or is open and let's the blood into the right ventricle so that's also what we already talked about so from that about that goes to the right ventricle and from the right ventricle then that will contracts the pulmonary semilunar about infants employees pumped to the lungs through the pulmonary arteries so let's talk briefly about that so that's right here see that here they're coming up and then it goes to the right to the left and then to the right over here so the best thing comes right off the heart is known as the pulmonary trouble let's write that over here pulmonary trunk and then right after look at this is very short right after that short little span he calls into a ride into a left vessel it splits right here it splits its crossing and at that point the one that goes to the left lungs is known as the left pulmonary artery even though it's blue that's that weird thing and a one that pumps work to the other side is known as to the right side is known as the right pulmonary order so in the vascular world in what face the world we often call something that is a little short stuff and then splits right into something else we call it a trough that will be strong it's good I get away with in the lab test I can call this a moment of trumps you don't have to worry about order your vein so it's that's confusing because it always gets us with the blue and red it still it gets me too that's why I always have to point it out in the heart is different all right so that makes that sense a little bit and then we in the lungs we're gonna exchange the gases so we oxygenate the blood we put oxygen in we get rid of the gases of the above the carbon dioxide and so then we have oxygenated blood returned to the back of the heart through the pulmonary veins and see you look at it and coming in right here the pulmonary veins are coming in right here for two on one side two on the other side the right ones and the left ones and on the model you're going to turn the model around now this is very turned around well actually don't have to turn it around because you see it right here there's two common right here you see those two in the front those are the left homes don't have pulmonary veins even though the red that's the artist asterisks to wrap with their veins and on the right they're going into the back right here and from there that they go into the while they go into the left atrium and from the left atrium we've gotta get the ball going into the left ventricle through the mitral valve pulmonary veins enter life nature the bicuspid valve opens and the blood goes into the left ventricle from there and the world when that when a blood pumps out of that left ventricle a pump well to all the body tissues delivering oxygen and nutrients to the body that includes the brain their arms the legs to this or everything except picking up oxygen in the lungs and it brings optional allusions to those tissues and it picks up waste products and carbon dioxide from those tissues to then again bring into the lungs and to the kidneys to filter everything so Anna ventricles contract the pressure inside this is important when the ventricles contract the pressure inside the ventricles rises and gets bigger until it's strong enough that the foam the block pushes to say me who were about open and from there then the blood is ejected through the in this left side the aortic semilunar valve into they are in trouble so you visualize the hearts down here the reason why it has to build a pressure on the inside until it's strong enough to push those valves open like the push the big fat door open and once it's open it goes faster because it has this energy that's built up and it's strong enough to push that wall over here already GARCH that's the already large you can see that right here and from the aura guard in the block the only guard goes down and basically here actually this first part we call it the a descending aorta then we call it the arch there and then this is the descending at work technically speaking I know and then further down stiffen erotic and then it goes down below the platform so that Domino or not but you see that word a or don't you thinking of that big thing going around but we will have these first three stops that come off they are is in the bracket boom boom boom so this here is another Trump we have to memorize them the first is known as the brachiocephalic oh look and then they messed me up with my sister see they're not consistent see here the cause the brachiocephalic artery we can also is also almost a troll they get away with it because there is no auto brake assist a like artery on the right or on the left it's just warm because brachial remember we're breaking what does that mean Oberon stone right cephalic means head so this brachial cephalic brings plug to the arm and the head that's how you read that stuff it sees a lot of it is slowing down on the reading list so the brachiocephalic trunk is very short and you can only see that here but here you can see how then splits into it right subclavian and a right common carotid artery subclavian we are never claimed in clavicle clavicle collarbone saw means below submarine below the water so stop claiming arteries right below the clavicle and then once it goes into the armpit they call it axillary artery and then he goes to the I'll probably call it brain killer that's where all that first chapters don't comes back the common carotid is the one that goes into the brain brain and face on the head the headstone so that's the first stop or you're coming off from the order is important stuff because that's delivering your walk to the brain you definitely want that hold for a burger and then the second stop is the left common carotid artery and the third stop is the left subclavian order which basically tells you on the right side you've got the first little stone but any splits into so flavor them carotid on the left side just come up right from the arch into the head and then into the arm and it makes sense that the last go goes to the arm and the second level is to the head otherwise you're going to cross them over so whenever you think that you know most of the body stuff is quite efficient the way we're doing it it's layered it's not let me get to the brain we learn about that we have different brains and so to speak and they have to do with evolution but it's usually quite efficient all right so that's that does that make sense first time around a little bit mostly memorize who finished talking way too long how look this is a picture that you started all this way look at how pretty it is you see all the chordae tendineae you see the three flaps here you see them so the two flaps here it's a night terror and that brings me to the coronary vessels the heart muscle itself needs what to supply its own function and the coronary arteries come out of the aorta at the base you can see that right here right here it's a nice picture and from there that's nicely oxygenated blood from there they go and feed the heart muscle itself we have a right coronary artery known as the RCA that's not a TV and that feeds the right ventricle and the majority of the hearts posterior the poster descending branch comes off with descending means it goes down on the left side we have the left coronary arteries and LCA they're like abbreviations it's Patel home and that feeds the front of the heart it divides into a left circumflex and enter descending in a ventricular branch whoa well I've got to go through that because that that ones on the test so the left the right side you can see it how it comes right out of here that's where it comes out so that's kind of nice to see that so we want to know that's the right coronary artery and then on the left side you cannot see but it comes out of the orders behind it but you can see a little stomping coming out of here and then it splits right there right into the one going straight down is to interventricular artery the anterior to retreat the laundry because it goes right on the interventricular septum that's the septum between two ventricles interventricular septum interventricular artery right and the other one that goes around sort of in between the ventricle and atrium is known as the circumflex because it it goes around that's just the circles around circumflex there we go that's these and then well they also have of course veins so the mark also gets fed and then when it's you know the body's finished off it has to come back and it comes back through veins most of the veins have similar names but the one thing I want to point out is in the back here at the heart I gotta figure off in the back here of the heart you see how this is a little bit of a bulging way it's a little bit of a bigger mean that's a call that a sinus so then this like a sign is in the skull it's a little chamber where Walton pool in a little bit or come together and here is called the coronary sinus and it collects the ball a little bit in any dump city to right atrium which is kind of you know that's where the ball comes in from the rest of the bodies with novena cave as well and then from there to vulcan cycles goes to the lungs gets oxygenated and y'all they got as we go back around good well the next thing now we have to talk about how does the heart muscle contract and the heart muscle is kind of interesting it has a as own source of impulse production initiation initiating an emotional contraction so it has its own nervous system so top here right bearish it has what's known as a sign of age real note as they know and that's interesting those are like cells muscle cells that leap calcium and when they leak it off the fiber nerve impulse off like you leaky cells are responsible that you're firing a turbine post yes man yeah let's steal electricity yeah when you when we're talking about the urban poles were talking about electrician we got to actually have a whole chapter that's a good question it's a little ahead of myself yeah because when you talk about muscles you gotta have the muscles need to be initiated or irritated by self with any contractions and that's a nerve and so the heart muscle is just a regular ball so from that perspective it has to be told to contract it's not just going to do that and we do that through the electrical impulse and so most of that comes from the brain for the body but the heart is unique and it's all that it has its own nervous system that way and it's only impulse impulse creation and it does that about 60 to 70 times per minute as an impulse so 62 times 60 to 70 times per minute you're going to get a discharge of a nerve impulse from this end here from the SA node in the sense that impulse through up here through the atria but it also sends it down here towards the ventricles and right there in the wall of the a teenager and the ventricles we got to have another note another cluster of cells that are like this charging impulses also is known as the AV intraventricular node and so that's around or actually know what I mean you stays nice over that the SA node is on top here so that's on top here so the impulse goes through the atria and then this is actually the AV node in the plane like right in here and in that when that when that gets stimulated it enforces the impulse or gets stronger and it goes down in between through the interventricular septum and around the ventricle and all together that vegetable that will be fed is an impulse it attracts all at once as a human so that's pretty so the names for these things are say sinoatrial node AV node a to ventricular node and then and as we get from the AV know we have a thing called the bottom of his that carries the import through the fiber skeleton and then as he gets down into the interventricular septum we call those two right and left bundle branches coming down here and as they go around they then change a name for some reason ejaculate and they called Purkinje fibers I need you to remember all the way but it's good to have them somewhere when you come back and you want to know because somebody says in a report well at the level of the Purkinje fibers to thing didn't spread like what the heck I never have to look interesting I'm just saying just in case but those are those Navy things for that so that's the anatomy of the cause option system of the heart the way that this conduction system works with the SI don't go first it actually contracts the atria a little bit and a little bit before the ventricle contracts so that's kind of cool because now you can have blood coming in to the ventricles see clearing slowly and going to the I mean to HR going into the ventricles and at some point the top contracts likely to push it a little more into it so push the blood a little bit more to the ventricles and then that stimulation goes over the ventricles and a little delayed that the vegetables will contract and then they send all that they said all the block to the through the through the body of the walls the cardiac cells they are actually not just it's not just one loss on the whole heart it is multiple many muscles put together and what they are they are they are having chopped to deliver let me talk about Johnson's in the epithelial tissue the desmosomes into the tight junctions the watertight ones and then the Cotter gap junctions and I said that's kind of common a heart muscle and so the gap junctions are like little channels between one heart muscle in the next heart muscle and they let ions go through and so they landed as stimulus and impulse and nerve impulse go straight through them so that's why the heart all the cells together can contract as one unit and they don't all contract individually they don't all have to have a nerve going to them and stimulating them not like the many skeletal muscle has to so they call that when they contract together as a unit they call it a functional syncytium so that's functionally speaking they work as one unit even though there are many different cells that are attached to one another so that's kind of interesting and then of course the frequency and the force of the more so the heart contraction heart muscle contraction can be influenced by brain that's why I mean also the heart starts pumping for no frickin reason you thinking and he's going all fast and that later on I realized why I was the case the brain influences that okay changing the intrinsic nervous system of the heart does not does not understand if we're doing exercises were a percent differential super-happy if it does not respond to that and you know it's very interesting I mean I have one patient she's a neuroscientist from Russia and she had her heart start of being a red making so it's awkward yet to her pacemaker and and she really felt sluggish in like I can I don't care about the rule that love and then after the heart was sort of set right and fine-tuned they have to find to list off it's really interesting get hooked onto a computer her energy level is all back and it's like she cares about things it's not just Janice she's not just the opportunities also like you know the hearts de-seed of the soul she came in and Luther and she's like I am so that's kind of interesting so we have to be you know scientific let me think on everything is in the brain [Music] we also know when we talk about the gut we know that the God has more nerves going to the brain that the brain has to told south we'll talk about that some more so that's also interesting why I think the Gulf feeling and there's a very important feeling than understanding that we'll have the reverse is from the government anyway so so far the heart has its own nervous system that generates impulses but it can't be influenced by the brain and brain stem and also the forehead where we have thinking good and that have you seen I did a few of them I couldn't do too many [Music] right so the paper print that looks like that and so we have these different wave things to come up and so this measures electricity going through the muscle so we have the first little bump here that we see is called the P wave and the P wave is when the cells discharge the electrical impulse goes over the atrium so this is spread of the excitation that's a nerve impulse excitation over the atrium and at we get this big QRS complex that's right and Q are as complex and that's when the ventricles get excited so the electrical spread over the vegetable is much bigger than over the over the HR you can see that difference that little bump here that big thing here and then at the end there we have a normal bump and that's known as the T wave and the teammate is when the ventricles repolarize when the nerves reset repor as you can sort of think of it a nerve reset the nerves have to reset a little bit because nerve impulse has to do with ions with minerals things ions going from one side of a cell membrane to the Orang so you mess up the chemical mixture and you have to reestablish that chemical mixture and that's a reset so we'll talk about that when we get to the nerves more but that's your electrocardiogram so the electricity going over the over the heart P wave QRS complex and t way and so in a heart contractures we know that as a systole when the heart relaxes we know that as diastole so the heart because this contract with that contract with that contract relax and with that slow is that rhythmic contraction it pushes a few a little small volume of blood forward every time it contracts and after it contract it has to relax because if you contracted the Valka it's pushed up and out of it if it keeps contracting there's no more refilling going on so it has to relax so the ball can refill so we have something so so blocked to then be pumped out of the heart again so that's very going forward and the heart valves we talked about that already they make sure that the block just flows in one direction and doesn't fall backwards that wouldn't be efficient but when it comes to the heart valves we have these sounds associated with it and so the closure of the heart piles makes the sound and the first sound the love you hear the first time is a love sound that's like the AV valves closed when the ventricle store contracting and then the second heart sound is the dub sound loved up and that's when the semilunar valves closed then the heart goes into diastole love them and we can listen to them maybe listen let me call that auscultation live them to the valve closure it's very important to examine the sounds are conducting while the broad stream and our easiest heard where the vlog travel closes to the chat so you can listen to these valves we prepare different parts of the chest and you hear different valves faites even though they're not right there they are that's where the sound is projected so I put a little off here so you can sort of see where they are in case you worry madam many heart valves is pathologically distorted and cannot open we call that stenosis cannot open is known as stenosis or it cannot closed properly we call that insufficiency and that creates lots turbulence because our heart and that we call it a heart murmur so you can sort of understand if it's if it's stenosis or if it's insufficient because like is it's the nose then you have an AV valve that doesn't open then you get a Shh and then you get the hard sound because the heart time is many closes so if it's not opening filling it out the turbulence it should sound before it closes and the closing is a lot if the sound the shushing is after the LOB after closes you know it seems sufficiently closing because the block goes back but it shouldn't go back and so you can slowly then when you hear things you know that's what they do they record all that stuff that they measure it and it's incredible how much they do in the heart understand how the heart works through hearing they have this microscope the stethoscope now that are like you know they are they are like seismic technology picking up all the little things that are happening in there it's not it's very very interesting I did the workshop on that at some point and that gets me to the cardiac cycle and so this is a really cool chart because here you can see everything that you need to know so and this is just when you trace the blood around the heart what happens as we go so we have on each side of the heart on the right side and on the left side this happens simultaneously so the first thing that happens we have to the eighth choice is filling up with block the block goes into the ventricles at that point the AV valves are open and the block flows passively from the age of two the ventricle and then we get a little contraction of the injury that's when the SA node fires that impulse over the atria we call it an atrial kick that's when the atrium pushes all the while it's got into the ventricles and that counts for about 20% of the filling and at that point that after that we have a ventricular contraction the first part is an isovolume metric ISO means same volume means the volume how many quarts are in there so I suppose metric means there is no block leaving the ventricles the whole blood stays in there during the early phase of systole the ventricular myocardium contracts with the semilunar valves are not yet open mister AV valves closed the ink truck ventricular to a pressure rises rapidly until it's strong enough that it can push the semi-nude arousal and at that point we have been triggered ejection so then it's a initiated by an opening of the semilunar valve and truthfully myocardial contracts maximally ejection about 70 milliliters of blood each time two contracts and we call that a stroke volume each stroke that time Walter and then after that we have a nice volumetric relaxation with DeMaio that's very brief moment but with the myocardium relaxing that intraventricular pressure falls below the arterial pressure closing the semilunar valves but the AV valves are still closed briefly before they open and the harp also relaxes enough and then we go right off back to here we fill up this pot so this is how the cycle goes so on this piece here up here you see the electrocardiogram down here you see the heart sounds first is love second is done love done here you see the pressure inside the heart you see here that pressure in a trail yeah in that left atrium the pressure in the left ventricle see when the ventricle contracts and it doesn't open all that it goes straight up up up up up at some point the valves open and then relax and then the pressure can escape the ventricle and then here we see the volume how much blood is in there see it fills up and many dentists dimensional empties it goes all the way down and then he fills open it and here you see the valves are they open or closed both vows and then here you about the visual flourish the block horn this is a very mature it gets you very far in understanding this vascular dynamics and look at that that's the last line so we then have to measure how much wealth to be pump each minute and he said that the stroke volume is how much we permit per know how much we pump per pump big-time per strike force attraction and that's about 70 milliliters at rest that can double you can have a tea well if the hardball is stronger it it can be stretched a little bit more - and so that's the dope and then the other thing we need to figure out how much water is pumped per bed I mean you know how many times were pumping that thing in a minute and that's the heart rate and that's at rest about 70 beats a minute more or less and so then we can calculate look at that we could go 70 times 7 is 49 on 4900 milliliters per minute I don't science you're going to milliliters Destin leaders leaders all that kind of stuff milliliter the equivalent of narrator but I know that's about 5 liters in the court I mean the gallon is about three point six liters so that's a well blow and look at that the cool thing is you can add maximal exertion you can go through 70 beads to about 180 beats a minute although when you look at maximum heart rate you do 220 minus your age so 180 is about 30 years old person and so be you know I mean those are all sort of all point fingers but if you do that that's about 25 litres in a minute that's five times the heart can pump five times interesting quantity if it needs to do that for brief moments so that's what you do when you need to run away from a lion or something buddy that was pretty good yeah well that's a full-fledged sympathetic overtaking I know I mean maybe freeze right anyway so that's what I have for this situation here