Anatomy

How fibrous pericardium is shaped

Cone shaped

Boarders of Fibrous Pericardium

Apex → Surround Great Vessels

Base → Adherent to Diaphragm (Central Tendon)

Sides → related to Cardiac Nerve/ Cardio phrenic vessels

Anterior → attached to (superior- Inferior) sterno-pericardial legaments

Posterior → related to posterior mediastinal structures( esophagus- Ascending Aorta)

What is the bare area of Pericardium

* Anteriorly not covered by any structure
* Costal Cartilage 4-6

Pericardial Sinuses

* Oblique → Superior
* Transverse → posterior

Arterial Blood Supply to Pericardium

Right → pericardiophrenic

Left → Musclophrenic

Posterior → descending thoracic Aorta

Venous Blood Supply to Pericardium

Azygos System

Nerve Supply to pericardium

* Rt, Lt Phrenic nerves (somatic nerves) → Fibrous pericardium + parietal serous pericardium

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* Autonomic Nerves (insensitive to pain) → Visceral serous Pericardium

Pericarditis

* Inflammation in the serous pericardium
* Make friction rub with contraction of heart
* increase of pericardial fluid = Pericardial effusion

Pericardial Effusion

* no Atrial Filling + Venous Return

→ Cardiac Tamponade -----fixed by---→ peri Cardiac Centesis

---through-→ bare Area of pericardium

Parts of both atria

* Smooth Parts
* Rough Parts

Rough Part of Rt Atrium

* internal aspect of ANTERIOR wall
* Has
* Crista Terminalis
* Pectinate Muscles

What is Crista Terminalis

* Muscular Ridge that is the origin if Pictinate Muscles
* It is parallel to ( Sulcus Terminalis)

Smooth Part of RT atrium

* internal Aspect of POSTERIOR wall
* recieves SVC (no valve) + IVC (redumintery valve)

\+ Coronary Sinus (Developed Valve)
* Has
* Fossa Ovalis + its Limbus in the septal Wall

Rough Part of LT atrium

* just the Auricle → pectinate Muscle

Smooth Part of RT atrium

* Most of the atrium
* recieves Pulmonary veins (Valveless)
* impression of fossa Ovalis in the septal wall

Parts of both Ventricles

* Rough → inflowing
* Smooth → outflowing

Rough part of RT Ventricle

* inflowing Part
* Sponge-shaped → Trabeculae Carni

Muscle types in Trabeculae Carni

3 Types

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* Fixed Ridge
* Papillary

- Count : 3 → Tricuspid valve

- Attached base , free apex

* Septomarginal
* 2 attached bases, 1 free apex
* functions
* Mechanical -→ xx septum distension
* Electrical Flow

Smooth part of RT Ventricle

* outflowing Part
* Funnel-shaped → infundibulum / Conus Arteriosus

Rough part of LT Ventricle

* inflowing Part
* Trabeculae Carni --------------------
* Finer, more branching
* only 2 of papillary muscles --→ bicuspid

Smooth part of LT Ventricle

* outflowing part
* called (Aortic vestibule)

Thickness of LT ventricle = ---------- Rt ventricle

3 times

Atria-ventricular Valves

* Tricuspids
* Bicuspids / Mitral

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Have

* Cuspids
* Chordae Tendinea
* Papillary Muscles
* Fibrous Ring

Tricuspid Orifice

* Large
* Triangular

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Tricuspid Valve

* 3 Cusps → Anterior, Posterior, Septal
* Cusps Apex → towards Ventricle
* Cusps Base → towards Atrium
* 2 Surfaces
* Smooth → Atrial
* Rough → ventricular---→ attached to chordi Tendinea

Mitral Orifice

* Circular
* Small

Mitral Valve

* 2 Cusps : anterior, posterior

\-----------Same as Tricuspid-----------------------

Semilunar Valves

* 2 margins

\-------------------------------
* free margin
* Concave
* has Nodule (Central Fibrous Thickness)
* has Crescentic band (lunule)

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attached margin

- Convex

- attached to Blood vessels

* each cusp has a sinus

Pulmonary Orifice

* 3 CM
* present at Conus Arteriosus

Pulmonary Valve

3 semilunar Cusps : 1 Posterior . 2 Anterior

Aortic Orifice

* 2,5 CM
* present at Aortic Vestibule

Aortic Valve

* 3 Semilunar Cusps: 2 Anterior , 1 Posterior
* Anterior Aortic Sinus --→ RT coronary artery
* Left Posterior Aortic Sinus -→ LT Coronary Artery

Cardiac Groove

three Grooves

* Atrioventricular Groove- Coronary sulcus/groove
* InterAtrial groove
* interventricular groove

Atrioventricular Groove

contains the coronary sinus

interatrial Groove

* covered anteriorly by the ascending aorta and the main pulmonary artery
* visible to the right of the heart as a fatty line between the superior vena cava and right superior pulmonary vein

Interventricular groove

* runs anteriorly toward the apex and contains the great cardiac vein. Posteriorly, it continues along the inferior surface of the heart toward the right margin and contains the middle cardiac vein

Surface Anatomy of Cardiac Valves

Primo A7san Men Terso

* Pulmonary → 3rd Lt costal Cartilage
* Aortic → 3rd Rt intercostal space
* Mitral → 4th LT Costal Cartilage
* Tricuspid → 4th LT intercostal Space

Auscultation of valves

* Pulmonary → 2nd RT intercostal Space
* Aortic → 2nd LT intercostal Space
* Tricuspid → 5th intercostal Space (near sternum)
* Mitral → 5th intercostal space (near heart apex)

Parts of interventricular Septum

* Muscle Part
* Membranous Part
* -------------------------------

has 2
* portions
* Boarders

Muscle Part of IV septum

* Lower Part
* Thicker part

Membranous Part of IV septum

* Fibrous
* Oval
* Upper
* Smaller
* Buldging to the right

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Portions of IV Septum

* Anterior → seperating septum
* Posterior → seperating Aortic vestibule & Rt atrium

Consequences of the Iv septum buldging to the right

* Rt ventricle → semilunar
* LT ventricle → circular

Blood Supply to the heart

* RT & LT Coronary Arteries

Origin of RT coronary Artery

* Anterior coronary sinus of ascending Aorta

Pathway of RT coronary Artery

Coronary Sulcus

End of RT coronary Artery

* at posterior part of coronary sulcus
* as an anastmosis with (Circumflix branch)

Branches of RT coronary artery

* SA nodal → 65%
* Rt marginal
* Rt Conus
* Atrial & ventricular branches
* Posterior IV artery

Posterior IV artery supplies what

* Av node → 80%
* Posterior 1/3 of IV septum
* both ventricles

origin of LT coronary Artery

* LT posterior coronary sinus of Ascending Aorta

Pathway of LT coronary Artery

behind Pulmonary Trunk , then between it and LT auricle

End of LT coronary Artery

* once reaching the coronary groove

Branches of LT coronary Artery

* anterior IV artery
* Circumflex Artery

what Anterior IV artery Supplies

* LT Conus
* both ventricles
* Anterior 2/3 of septum

what Circumflex Artery Supplies ?

* LT marginal
* Atrial & Ventricular Branches
* SA node → 35%
* AV node → 20%

Variations of Coronary Arteries

* RT dominance
* LT dominance
* Co-dominance

RT coronary Dominance

* Posterior IV Artery arise from RT coronary
* Most Common (67%)
* Both coronaries are equal

LT coronary Dominance

* Posterior IV Artery arise from LT coronary(Circumflex)
* Less Common (15%)
* LT coronary has major role
* More danger

Co-dominance

* no clear posterior IV artery
* Branches of both artery
* in 18%

Venous Driange of Heart

* Coronary Sinus
* Anterior Cardiac Viens
* Venae Cordis Minimi

Coronary Sinus

* short Wide channle
* Posterior Coronary Groove (left → Right)
* Between LT atrium & LT Ventricle
* opening in RT atrium (left to IVC)
* Guarded by small valve

Tributaries of Coronary Sinus

* Great Cardiac Vein
* Middle Cardiac vein
* Small Cardiac Vein
* Posterior vein of LT ventricle
* Oblique Vein of LT ventricle

Pathway of Great Cardiac Vein

* same as anterior IV artery

Pathway of Middle Cardiac Vein

* same as Posterior IV Artery

Pathway of Small Cardiac Vein

between RT chambers

Anterior Cardiac Veins

* 2-5 small veins
* run on anterior wall of RT ventricle
* open in anterior wall of RT atrium

Venae Cordis Minimi

* minute small veins
* start in myocardium
* open in all chambers especially RT ones

does RT atrium recieves all venous driange

no all chambers recieves deoxygenated blood

Lymphatic Drianage of Heart

3 Plexuses -----→ 2 Trunk (Coronary Grrove)----------

\---------

* RT ----into --→Brachiocephalic
* LT-------into→ inferior tracheocephalic

Nerve Supply of Heart

* Sympathetic Innnervation
* ParaSympathetic Innervation

Sympathetic Innervation

* post ganglionic
* Reach
* SAN
* AVN
* Cardiac Muscle
* Coronary Arteries
* originate from
* Cervical ganglia
* Upper thoracic ganglia

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Parasympathetic Innervation

* Pre ganglionic
* they are cardiac branches of vagus nerve
* reach
* SAN
* AVN
* Coronary Arteries

Arteries of Thorax

* Aorta
* Subclavian Arteries
* Internal Throacic
* Intercostal Arteries

Parts of Aorta

* Ascending
* Arch
* Descending

Beginning of Ascending Aorta

* Aortic Valve

Branches of Adcending Aorta

* Coronary Arteries

Beginning of Aortic Arch

* 2nd right sterno-costal joint at the level of Sternal Angle

Pathway of Aortic Arch

Upward, backward the the the left of Trachea

End of Aortic Arch

* T4 Vertebrae (sternal Angle)

Branches of Aortic Arch

* Brachiocephalic trunk / inominate
* Lt common Carotid
* LT Subclavian Artery

BRANCHES OF iNOMINATE trunk

* Rt common Carotid
* RT subclavian artery

Parts of Descending Aorta

* Thoracic
* Abdominal

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seperated by th Diaphragm

Extents of thoracic Descending Aorta

* T5 Vertebrae to T12 Vertebrae

Extents of Abdominal Descending Aorta

* T 12 to L4 vertebrae

Division of Abdominal Descending Aorta

* Common iliac Arteries

Branches Of thoracic Aorta

* Somatic
* Visceral branches

Somatic Branches Of thoracic Aorta

* Posterior intercostal Arteries
* Superior Phrenic Artery

Visceral Branches Of thoracic Aorta

* Bronchial
* Pericardial
* Esophygeal
* Mediastinal

Branches of Abdominal Aorta

* Somatic
* Visceral

Somatic Branches of Abdominal Aorta

* Inferior Phrenic artery
* Lumbar Arteries → (vertebrae -spine- abdominal wall)

Visceral Branches Of Abdominal Aorta

* Single Front Arteries
* Paired side Arteries

Single Front Branches of Abdominal Aorta

* Ciliac Artery → foregut
* Superior Mesentric → Midgut
* Inferior Mesentric → hindgut

Paired side Branches of Abdominal Aorta

* Adrenal
* Renal
* Gonadal

apex position

5th intercostal space

3,5 inch from midline

what makes the apex

Lt ventricle

Sterno-costal surface of heart composed of

2/3 Rt chambers and 1/3 Lt chambers

Anterior IV groove contains what vessels

Anterior IV artery

Great Cardiac Vein

ant. Coronary Groove contains

Rt coronary artery

post. part of coronary groove

contains coronary sinus

what forms Diaphragmatic

2/3 Lt ventricle , 1/3 Rt ventricle