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Ukranian Medical Stomatological Academy” MINISTRY OF PUBLIC HEALTH OF UKRAINE Higher State Educational Establishment of Ukraine “Ukranian Medical Stomatological Academy” "Approved" at the meeting of the Department of Human Anatomy «29»_08__2017 Minutes №1 Head of the Department Professor O.O. Sherstjuk ________________________ METHODICAL GUIDANCE for students' self-directed work at practical sessions (when preparing for and during the practical session) Academic subject Human Anatomy Module №3 «The heart. Vessels and nerves of the head, the neck, the trunk, extremities» Year of study І-II Faculty foreign students' training faculty, specialty «Medicine» Poltava – 2017 MINISTRY OF PUBLIC HEALTH OF UKRAINE Higher State Educational Establishment of Ukraine “Ukranian Medical Stomatological Academy” Department of Human Anatomy Composed by: N.L. Svinthythka, Associate Professor at the Department of Human Anatomy, PhD in Medicine, Associate Professor V.H. Hryn, Associate Professor at the Department of Human Anatomy, PhD in Medicine, Associate Professor A.V. Pilugin, Associate Professor at the Department of Human Anatomy, PhD in Medicine, Associate Professor A.L. Katsenko, Lecturer at the Department of Human Anatomy Schedule of classes for students of foreign students' training faculty, specialty “Medicine” on module №3 "Heart. The vessels and nerves of the head, neck, trunk and extremities " № Topic hours 1 Anatomy of the heart: external structure, the cardiac chambers, wall 2 structure of the heart. 2 Anatomy of the heart: vessels and nerves of the heart, the conducting 2 system of the heart. 3 Circles of blood circulation. The pericardium. Topography of the heart. 2 4 The aorta. The branches of aortic arch. The common carotid artery. 2 The internal carotid artery. 5 The external carotid artery. 2 6 The subclavian artery. The axillary artery. 2 7 Blood supply of the brain and spinal cord. Anastomoses. Clinical 2 aspects. 8 Arteries of upper extremity. 2 9 Thoracic aorta. Parietal and paired visceral branches of abdominal 2 aorta. 10 Unpaired visceral branches of abdominal aorta. 2 11 Iliac arteries. Arteries of the thigh. 2 12 Arteries of lower extremity. 2 13 General characteristic of venous system. System of vena cava 2 superior. Veins of head and neck. 14 System of vena cava superior. Veins of upper extremities and chest. 2 15 System of vena cava inferior. Veins of lower extremities, pelvis and 2 abdominal cavity. 16 System of portal vein. Fetal circulation. 2 17 Immune system. Organs of haemopoesis. Central part of the immune 2 system. The red bone marrow. The thymus. 18 Peripheral part of the immune system. The lymph nodes. The spleen. 2 The tonsils. The lymphoid nodules. 19 Lymphatic vessels and nodes of the lower limb, pelvis and abdomen. 2 20 Lymphatic vessels and nodes of the head and neck. 2 21 Submodule on Cardiovascular system and immune system. Situational 2 problems. 22 General characteristics of the peripheral nervous system. The spinal 2 nerves. The posterior rami of the spinal nerves. The anterior rami of the spinal nerves. The cervical plexus. 23 The brachial plexus. 2 24 The intercostal nerves. The lumbar plexus. 2 25 The sacro-coccygeal plexus. 2 26 Cranial nerves. The origination, the general features, the featured 2 nuclei, the point of arise, the escape point, the related branches and the responsibility areas of the oculomotor, trochlear and abducent nerves. 27 The origination, the general features, the featured nuclei, the point of 2 arise, the escape point, the related branches and the responsibility areas of the trigeminal nerve. Nervous pathway of the trigeminal nerve. 28 The facial nerve. The intermediate nerve. The origination, the general 2 features, the featured nuclei, the point of arise, the escape point, the related branches and the responsibility areas. 29 The glossopharyngeal nerve. The related branches and the 2 responsibility areas. 30 The vagus nerve. The origination, the general features, the featured 2 nuclei, the point of arise, the escape point, the related branches and the responsibility areas. 31 The accessory, hypoglossal nerves. The related branches and the 2 responsibility areas. 32 Submodule on peripheral nervous system. The spinal and cranial 2 nerves. Situation problems. 33 Introduction in vegetative nervous system. Sympathetic part of 2 autonomic nervous system. 34 Parasympathetic part of autonomic nervous system. 2 35 Autonomic innervation of organs. Autonomic ganglions of head and 2 neck, pelvis, abdomen. 36 Synthetic classes: vascularization and innervation of the chest cavity, 2 abdominal cavity and the pelvic cavity. 37 Vascularization and innervation of organs of head and neck. 38 Synthetic classes: vascularization and innervation of the limbs. 2 39 Practical skills from the training material module 3 «Heart. Vessels 2 and nerves of the head, neck, chest cavity and extremities». 40 Case-control material of the module 1 «Anatomy of the locomotor 2 apparatus». Step 1. Practical skills. 41 Case-control material of the module 2 «Splanchnology. Central 2 nervous system and sense organs». Step 1. Practical skills. 42 Final semester certification (exam). 2 Topic 1. Anatomy of the heart: external structure, the cardiac chambers, wall structure of the heart. 1. Relevance of the topic. The heart is a hollow contractile muscular organ that lies within the pericardium in the mediastinum in the thorax. The heart is responsible for pumping blood through the pulmonary and systemic circulations. 2. The specific aims. 2.1.To have general knowledge of the topic studied; 2.2. To understand, to remember and to use the knowledge received; 2.3. To form the professional experience by reviewing, training and authorizing it; 2.4. To be able to find and show studying structures on visual aids. 3. Basic knowledge and skills necessary for study the topic (interdisciplinary integration) The preceding The acquired knowledge subjects Biology What are the main vessels of the systemic and pulmonary circulations Histology Structure of tissues which form the walls of the heart Cardiology Find the auscultatory points for the heart valves. What are the components of the components of the conducting system of heart 4. Tasks for students' individual work. 4.1. The list of basic terms, parameters, characteristics which the student should master while preparing for the class: Cor (Greek. cardia) Heart Ventriculus cordis dexter/sinister Ventricle right / left Auricula dextra, sinistrа Right / left auricle Anulus fibrosus dexter/sinister Right / left fibrous rings M. papillaris Papillary muscle Trabeculae carneae Trabeculae carneae 4.2. Theoretical questions for the class: 1. Surfaces and borders of the heart. 2. Structure of the walls of the heart. 3. Chambers of the heart, structure of the right atrium. 4. Structure of the left atrium. 5. Structure of the right ventricle. 6. Structure of the left ventricle. 7. Structure of interventricular septum. 4.3. Practical task pertaining to the topic and to be completed during the class: on the preparations, tables, models to study the external structure of the heart, its shape, position, heart chambers, structure of the heart, heart valves, heart wall structure. Content of the topic. The heart, slightly larger than a clenched fist, is a double self-adjusting muscular pump, the parts of which work in unison to propel blood to the body. The right side of the heart receives poorly oxygenated blood from the body through the superior vena cava (SVC) and inferior vena cava (IVC) and pumps it through the pulmonary trunk to the lungs for oxygenation. The left side of the heart receives well-oxygenated blood from the lungs through the pulmonary veins and pumps it into the aorta for distribution to the body. The heart has four chambers: right and left atria and right and left ventricles. The atria are receiving chambers that pump blood into the ventricles—the discharging chambers. The synchronous pumping actions of the heart's two atrioventricular (AV) pumps (right and left chambers) constitute the cardiac cycle. The cycle begins with a period of ventricular relaxation (diastole) and ends with a period of ventricular contraction (systole). Two heart sounds—resulting from valve closures—can be heard with a stethoscope: a "lub" sound as the atria transfer blood to the ventricles and a "dub" sound as the ventricles contract and propel blood from the heart. The heart sounds are produced by the snapping shut of the one-way valves that normally keep blood from flowing backward during contractions of the heart. The wall of each chamber of the heart consists of three layers from superficial to deep: • Epicardium, a thin external layer (mesothelium) formed by the visceral layer of serous pericardium. • Myocardium, a thick middle layer composed of cardiac muscle. • Endocardium, a thin internal layer (endothelium and subendothelial connective tissue) or lining membrane of the heart that also covers its valves. When the ventricles contract, they produce a wringing motion because of the spiral orientation of the cardiac muscle fibers in the myocardium. This motion propels the blood from the heart. The muscle fibers are anchored to the fibrous skeleton of the heart. The fibrous framework of dense collagen forms four fibrous rings, which surround the orifices of the valves, right and left fibrous trigones, formed by connecting the rings, and the membranous parts of the interatrial and interventric- ular septa. The fibrous skeleton of the heart: • Keeps the orifices of the atrioventricular (AV) and semilunar valves patent and from being overly distended by the volume of blood pumping through them. • Provides attachments (origin and insertion) for the leaflets and cusps of the valves. • Provides attachment (origin and insertion) for the myocardium. • Forms an electrical "insulator" by separating the myenterically conducted impulses of the atria and ventricles so that they contract independently, and by surrounding and providing passage for the initial part of the AV bundle. The heart and roots of the great vessels within the pericardial sac are related anteriorly to the sternum, costal cartilages, and the medial ends of the 3rd through 5th ribs on the left side.
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