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Thursday, June 10, 2021

Clinical Depression

Clinical Depression

Clinical Depression

Clinical Depression


Clinical (endogenous) depression, a heterogeneous biopsychologic disorder with genetic predisposition, can occur at any time in life, unrelated to obvious stressors. Treatment is required: approximately 15% of these patients commit suicide. Severe (major depression) and mild (dysthymic disorder) forms exist.

Coronary Arteries and Cardiac Veins

Coronary Arteries and Cardiac Veins

Coronary Arteries and Cardiac Veins

BLOOD SUPPLY OF THE HEART

STERNOCOSTAL AND DIAPHRAGMATIC SURFACES
STERNOCOSTAL AND DIAPHRAGMATIC SURFACES


The normal heart and the proximal portions of the great vessels receive their blood supply from two coronary arteries. The left coronary artery (LCA) originates from the left sinus of Valsalva near its upper border, at about the level of the free edge of the valve cusp. The LCA usually has a short (0.5-2 cm) common stem that bifurcates or trifurcates. One branch, the anterior inter- ventricular (descending) branch, courses downward in the anterior interventricular groove (largely embedded in fat), rounds the acute margin of the heart just to the right of the apex, and ascends a short distance up the posterior interventricular groove.

Specialized Conduction System of Heart

Specialized Conduction System of Heart

Specialized Conduction System of Heart

Specialized Conduction System of Heart


The specialized heart tissues include the sinoatrial (SA) node, atrioventricular (AV) node, common atrioventricular bundle or bundle of His, right and left bundle branches, and peripheral ramifications of these bundle branches, which make up the subendocardial and intra- myocardial Purkinje network. In addition, other fiber groups in the atria meet some of the histologic and electrophysiologic criteria for specialization. These tissues constitute Bachmann’s bundle and the inter- nodal conducting paths of the right atrium.

Valves

Valves

Valves

CARDIAC VALVES OPEN AND CLOSED
CARDIAC VALVES OPEN AND CLOSED


Each atrioventricular (AV) valve apparatus consists of a number of cusps, chordae tendineae, and papillary muscles. The cusps are thin, yellowish white, glistening trapezoid-shaped membranes with fine, irregular edges. They originate from the annulus fibrosus, a poorly defined and unimpressive fibrous ring around each AV orifice. The amount of fibrous tissue increases only at the right and left fibrous trigones.

Atria and Ventricles

Atria and Ventricles

Atria and Ventricles

RIGHT ATRIUM

Atria and Ventricles


The right atrium consists of two parts: (1) a posterior smooth-walled part derived from the embryonic sinus venosus, into which enter the superior and inferior venae cavae, and (2) a thin-walled trabeculated part that constitutes the original embryonic right atrium. The two parts of the atrium are separated by a ridge of muscle. This ridge, the crista terminalis (see Plate 1-7), is most prominent superiorly, next to the SVC orifice, then fades out to the right of the IVC ostium. Its position corresponds to that of the sulcus terminalis externally (see Plate 1-6). Often described as a remnant of the embryonic right venous valve. the crista terminalis actually lies just to the right of the valve.

Exposure of the Heart

Exposure of the Heart

Exposure of the Heart

ANTERIOR EXPOSURE
ANTERIOR EXPOSURE


STERNOCOSTAL ASPECT

Within the pericardium lies the heart, a hollow, muscular, four-chambered organ suspended at its base by the great vessels. In situ the heart occupies an asymmetric position, with its apex pointing anteriorly, inferiorly, and about 60 degrees toward the left. Its four chambers are arranged in two functionally similar pairs, separated from each other by the cardiac septum (see Plate 1-5). Each pair consists of a thin-walled atrium and a thicker- walled ventricle.

Thorax

Thorax

Thorax

LUNGS IN SITU: ANTERIOR VIEW
LUNGS IN SITU: ANTERIOR VIEW


Before describing the anatomy of the heart, it is helpful to review other anatomic features of the thoracic cavity and organs.

Anatomy Physiology

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