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The Heart And Great Vessels

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The Heart And Great Vessels

The Heart And Great Vessels

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    • 1. The Heart and Great Vessels http://crisbertcualteros.page.tl
    • 2. The Heart
      • a hollow muscular organ of a somewhat conical form
      • lies between the lungs in the middle mediastinum and is enclosed in the pericardium
      • placed obliquely in the chest behind the body of the sternum and adjoining parts of the rib cartilages; projects farther into the left than into the right half of the thoracic cavity, so that about one-third of it is situated on the right and two-thirds on the left of the median plane.
      • Size.—The heart, in the adult, measures about 12 cm. in length, 8 to 9 cm. in breadth at the broadest part, and 6 cm. in thickness.
      • Its weight, in the male, varies from 280 to 340 grams; in the female, from 230 to 280 grams. It continues to increase in weight and size up to an advanced period of life; the increase more marked in men than in women.
    • 3. The Pericardium
      • - a conical fibro-serous sac , in which the heart and the roots of the great vessels are contained.
      • - placed behind the sternum and the cartilages of the 3 rd – 7th ribs of the left side, in the mediastinal cavity.
      • - In front, it is separated from the anterior wall of the thorax, in the greater part of its extent, by the lungs and pleuræ; but a small area, somewhat variable in size, comes into direct relationship with the chest wall, called the bare area of the pericardium .
    • 4. Pericardium
      • The membranous sac filled with serous fluid that encloses the heart and the roots of the aorta and other large blood vessels
    • 5.
      • Structure of the Pericardium
      • it consists essentially of two sacs intimately connected with one another, but totally different in structure.
      • 1) fibrous pericardium: the outer sac consisting of
      • fibrous tissue.
      • 2) serous pericardium: the inner sac
      • : a delicate membrane which lies
      • within the fibrous sac and lines
      • its walls
    • 6. Fibrous Pericardium
      • It is the outermost layer of the pericardial membranes around the heart. It is a tough, collagenous sheet that is superficial to the parietal layer of the serous pericardium. The two are separated by a thin layer of amorphous connective tissue.
    • 7.
      • Conical in shape, it fuses and is continuous with:
      • inferiorly: the central tendon of the diaphragm
      • superoposteriorly: the adventitial layers of all the great vessels except the inferior vena cava which enters the pericardial cavity through the diaphragm
      • anteriorly: the sternopericardial ligaments
      • deep: the layers of the serous pericardium over the heart
      • superiorly: the pretracheal fascia
    • 8.
      • The relations of the fibrous pericardium are:
      • anterior: anterior diaphragmatic surfaces of pleura except for small 'bare area' exposed by the cardiac notch where fibrous pericardium is in direct contact with inferior left half of body of sternum
      • posterior, from superior to inferior: principal bronchi, oesophagus, descending aorta, posterior mediastinal surfaces of lung
      • laterally: mediastinal surface of pleura, phrenic nerves and vessels
      • inferiorly: diaphragm
    • 9.
      • The relatively high tensile strength of the fibrous pericardium and its firm attachments ensure that:
      • it provides a relatively unyielding barrier to the overexpansion of the heart and pericardial cavity
      • its shape and position is influenced by the position of the diaphragm
      • it keeps the heart and great vessels roughly central within the thoracic cavity
    • 10. fibrous pericardium
    • 11. Serous Pericardium
      • The serous pericardium of the heart is a sheet of mesothelial cells which lines, and so demarcates, the pericardial cavity. During development, where the layer has been invaginated by the heart, it comes to be divided into two:
      • parietal layer of serous pericardium
      • visceral layer of serous pericardium
    • 12.
      • parietal serous- serous membrane lining the pericardial
      • cavity;
      • - located on the inner surface of the fibrous
      • pericardium;
      • - reflects onto the heart at the origins of the
      • great vessels to become continuous with
      • the visceral serous pericardium
      • visceral serous- serous membrane covering the surface of
      • the heart;
      • - reflects onto the inner surface of the
      • fibrous pericardium at the origins of the
      • great vessels to become continuous
      • with the parietal serous pericardium;
      • - also known as epicardium
    • 13. Serous parietal pericardium
    • 14. Anterior epicardium
    • 15. The Pericardial Cavity
      • the potential space formed between the two layers of serous pericardium around the heart. Normally, it contains a small amount of serous fluid that acts to reduce surface tension and lubricate. Therefore, the cavity facilitates the free movement of the heart.
      • Both layers secrete the serous fluid which serves to lubricate the surface of the pericardial cavity.
      • There may be a small fold of serous pericardium joining the left pulmonary artery to the superior left pulmonary vein within the pericardial cavity. This is the fold of the left vena cava.
    • 16. pericardial cavity
    • 17.
      • The cavity surrounds the heart and is continuous with it at all but the points of entry and exit of great vessels. The layers of pericardium form two distinct 'tubes' around groups of these vessels:
      • one interconnecting the:
        • inferior vena cava
        • superior vena cava
        • pulmonary veins
      • the other connecting the:
        • aorta
        • pulmonary trunk
    • 18.
      • The attachment of this visceral layer to the parietal layer presents the shape of an inverted U. The cul-de-sac enclosed between the limbs of the U lies behind the left atrium and is known as the oblique sinus , while the passage between the aorta and pulmonary artery in front and the atria behind—is termed the transverse sinus .
    • 19. Pericardial Sinuses
    • 20. Transverse Pericardial Sinus
      • Within the pericardial cavity a probe can be placed into the transverse sinus running posterior to the aorta and pulmonary trunk on the left but anterior to the left atrium and superior vena cava on the right.
    • 21. Oblique Pericardial Sinus
      • - is a blind ending passage posterior to the heart formed by the reflections of the visceral and parietal pericardium onto the vessels traversing the space.
    • 22. the two sinuses are not continuous
    • 23.
      •   The arteries of the pericardium are derived from the internal mammary and its musculophrenic branch , and from the descending thoracic aorta .       
      • The nerves of the pericardium are derived from the vagus and phrenic nerves , and the sympathetic trunks
    • 24. The Heart
      • Component Parts.—The heart is subdivided by septa into R and L halves, and a constriction subdivides each half of the organ into two cavities, the upper cavity being called the atrium , the lower the ventricle . The heart therefore consists of 4 chambers, viz., right and left atria, and right and left ventricles.
    • 25.
      • The division of the heart into four cavities is indicated on its surface by grooves:
      • coronary sulcus (auriculoventricular groove)
      • - separates the atria from the ventricles
      • interatrial groove
      • - separates the two atria
      • anterior longitudinal (interventricular) sulcus
      • - separates the ventricles
      • - situated on the sternocostal surface of the heart,
      • close to its left margin
      • - contain the ant. Interventricular a. & great cardiac v.
      • posterior longitudinal (interventricular) sulcus
      • - separates the ventricles on the diaphragmatic
      • surface near the right margin
      • - contain the post intervent. art. & middle cardiac v.
    • 26. Coronary sulcus
    • 27. interventricular groove
    • 28. Heart Exterior
    • 29. great cardiac v
    • 30. posterior of the heart, gross specimen
    • 31. post iv a.
    • 32. middle cardiac v.
    • 33. Surfaces of the Heart Base: directed upward, backward, and to the right : separated from the 5th - 8th thoracic vertebræ by the esophagus, aorta, and thoracic duct : formed mainly by the left atrium , and, to a small extent, by the back part of the right atrium : somewhat quadrilateral in form
    • 34.
      • The Apex: is directed downward, forward, and to the left, and is overlapped by the left lung and pleura: it lies behind the fifth left intercostal space , 8 to 9 cm. from the mid-sternal line, or about 4 cm. below and 2 mm. to the medial side of the left mammary papilla
    • 35.
      • The sternocostal surface is directed forward, upward, and to the left. Its lower part is convex, formed chiefly by the right ventricle, and traversed near its left margin by the anterior longitudinal sulcus.
      • Its upper part is separated from the lower by the coronary sulcus, and is formed by the atria; it presents a deep concavity , occupied by the ascending aorta and the pulmonary artery
    • 36.
      •   The Diaphragmatic surface , directed downward and slightly backward, is formed by the ventricles, and rests upon the central tendon and a small part of the left muscular portion of the diaphragm. It is separated from the base by the posterior part of the coronary sulcus, and is traversed obliquely by the posterior longitudinal sulcus.
    • 37.
      • Right margin: formed by the right atrium
      • above and the right ventricle
      • below
      • : the atrial portion is rounded
      • and almost vertical
      • : the ventricular portion is thin
      • and named the acute margin ,
      • because of the sharp angle
      • formed between the anterior
      • & diaphragmatic surfaces of
      • the R ventricle
    • 38.
      • Left or obtuse margin
      • : shorter, full, and rounded
      • : formed mainly by the left
      • ventricle , but to a slight
      • extent, above, by the
      • left atrium
      • :so called because of the
      • broad curving angle between the
      • diaphragmatic & anterior surfaces
      • of the left ventricle.
    • 39.
      • Note the three borders of the
      • heart:
      • right border (1) made up of the right atrium
      • inferior border (2) made up of right atrium, right ventricle and left ventricle
      • left border (3) made up of the left ventricle
    • 40. the anterior view of the heart
    • 41.
      • The adjacent figure shows the posterior aspect of the heart. Its identifiable features include:
      • right atrium (RA)
      • left atrium (LA)
      • right ventricle (RV)
      • left ventricle (LV). Notice that most of the left ventricle is posterior.
    • 42.
      • Right Atrium
      • - larger than the left
      • - walls are somewhat thinner, measuring about 2 mm.
      • - its cavity is capable of containing about 57 c.c.
      • - consists of two parts:
      • a) sinus venarum (sinus venosus)
      • : the large quadrangular cavity placed between the two
      • venæ cavæ
      • b) auricle (right auricular appendix)
      • : a small conical muscular pouch
      • : its margins present a dentated edge
      • : it projects from the upper and front part of the sinus
      • forward and toward the left side, overlapping the root
      • of the aorta
    • 43. sinus venarum
    • 44.
      • The separation of the auricula from the sinus venarum is indicated externally by a groove: the terminal sulcus that extends from the front of the superior vena cava to the front of the inferior vena cava
      • On the inner wall of the atrium the separation is marked by a vertical, smooth, muscula ridge, the terminal crest.
      • Behind the crest the internal surface of the atrium is smooth, while in front of it the muscular fibers of the wall are raised into parallel ridges resembling the teeth of a comb, and hence named the musculi pectinati .
    • 45. pectinate muscles
    • 46.
      •   Its interior presents the following parts for examination:    
      • Superior vena cava.
      • Valves: Valve of inf vena cava Inferior vena cava. Valve of the coronary
      • sinus Openings: Coronary sinus
      • Atrioventricular.
      • Fossa ovalis. Crista terminais
      • Musculi pectinati.
    • 47. R atrium, anterior view
    • 48.
      • Superior vena cava: returns the blood from the upper half
      • of the body
      • opens into the upper and back part of the
      • atrium
      • its opening has no valve
      • Inferior vena cava: larger than the superior vena cava
      • returns the blood from the lower half of the
      • body
      • opens into the lowest part of the atrium, near
      • the atrial septum
      • guarded by a rudimentary valve, the valve of
      • the inferior vena cava (Eustachian valve)
    • 49.
      • The blood entering the atrium through the superior vena cava is directed downward and forward, i.e., toward the atrioventricular orifice, while that entering through the inferior vena cava is directed upward and backward, toward the atrial septum. This is the normal direction of the two currents in fetal life.
    • 50. Openings of SVC
    • 51. IVC
    • 52.
      • Coronary sinus
      • opens into the atrium, between the orifice of
      • the inferior vena cava and the
      • atrioventricular opening
      • returns blood from the substance of the heart
      • protected by a semicircular valve, the valve
      • of the coronary sinus ( valve
      • of Thebesius ).
    • 53. coronary sinus
    • 54.
      • Foramina venarum minimarum (foramina Thebesii)
      • - the orifices of minute veins (venœ cordis minimœ),
      • which return blood directly from the muscular
      • substance of the heart.
      • Atrioventricular opening (tricuspid orifice)
      • - the large oval aperture of communication between
      • the atrium and the ventricle
    • 55.
      • Fossa ovalis
      • - an oval depression on the septal wall of the
      • atrium above and to the left of the orifice
      • of the inferior vena cava which
      • corresponds to the situation of the
      • foramen ovale in the fetus.
    • 56. FOSSA OVALIS
    • 57.
      • Right Ventricle
      • ~ triangular in form
      • ~ upper and left angle forms a conical pouch,
      • the conus arteriosus , from which the
      • pulmonary artery arises
      • ~ wall is thinner than that of the left, the
      • proportion between them being as 1 to 3;
      • ~ cavity equals in size that of the left ventricle,
      • and is capable of containing about 85 c.c.
      • ~ its interior presents the following parts for examination :
    • 58.
      • right atrioventricular orifice-
      • - the large oval aperture of communication between the right atrium and ventricle situated at the base of the ventricle,
      • - guarded by the tricuspid valve
      • opening of the pulmonary artery
      • - circular in form situated at the summit of the conus arteriosus, close to the ventricular septum
      • - guarded by the pulmonary semilunar valves .
    • 59.
      • tricuspid valve
      • - consists of three somewhat triangular cusps
      • or segment
      • trabeculæ carneæ
      • - rounded or irregular muscular columns
      • which project from the whole of the inner
      • surface of the ventricle, with the exception
      • of the conus arteriosus.
      • chordae tendinae
      • - delicate tendinous cords that connect the
      • apices and margins of the cusps as well as
      • the papillary muscles
    • 60. R ventricle internal features
    • 61.
      • moderator band
      • - a muscular band that extends from the base of the anterior papillary muscle to the ventricular septum.
      • pulmonary semilunar valves
      • - three in number, two in front and one behind
      • attached, by their convex margins, to the wall of the artery, at its junction with the ventricle, their free borders being directed upward into the lumen of the vessel.
      • Between the semilunar valves and the wall of the pulmonary artery are three pouches or sinuses ( sinuses of Valsalva ).
    • 62. modertor band and semilunar
    • 63.
      • Left Atrium
      • ~ smaller than the right, but its walls are thicker,
      • measuring about 3 mm
      • ~ consists, like the right, of two parts:
      • 1) The principal cavity
      • = cuboidal in form
      • = concealed, in front, by the pulmonary artery and
      • aorta
      • = in front and to the right it is separated from the
      • right atrium by the atrial septum
      • = opening into it on either side are the two
      • pulmonary veins.
      • 2) left auricle
      • = somewhat constricted at its junction with the
      • principal cavity
      • = directed forward and toward the right and
      • overlaps the root of the pulmonary artery.
    • 64.
      • ~ interior presents the following parts for examination:
      • pulmonary veins (openings)
      • - four in number and open into the upper part of the posterior surface of the left atrium—two on either side of its middle line
      • - not provided with valves
      • left atrioventricular opening
      • - rather smaller than the corresponding opening on
      • the right side
      • musculi pectinati
      • - fewer and smaller than in the right auricula, are confined to the inner surface
    • 65.
      • Left Ventricle
      • ~ longer and more conical in shape than the right
      • ~ forms the apex of the heart
      • ~ its walls are about three times as thick as those of the right ventricle.
      • ~ its interior presents the following parts for examination:
      • left atrioventricular opening Trabeculæ
      • carneæ.
      • Aortic opening Chordæ
      • Bicuspid or mitral valve tendineæ
      • Aortic valve
    • 66.
      • left atrioventricular opening (mitral orifice):
      • : placed below and to the left of the aortic orifice
      • : a little smaller than the corresponding aperture
      • of the opposite side
      • : guarded by the bicuspid or mitral valve
      • aortic opening
      • : a circular aperture, in front and to the right of
      • the atrioventricular, from which it is
      • separated by the anterior cusp of the
      • bicuspid valve
      • : its orifice is guarded by the aortic semilunar
      • valves
    • 67. sup view of aortic semilunar valve
    • 68.
      • bicuspid or mitral valve
      • : consists of two triangular cusps which are larger, thicker, and stronger than those of the tricuspid valve;
      • cusps are furnished with chordæ tendineæ, which are attached in a manner similar to those on the right side
      • aortic semilunar valves
      • : three in number, and surround the orifice of the aorta
      • : similar in structure, and in their mode of attachment, to the pulmonary semilunar valves, but are larger, thicker, and stronger
      • : opposite the valves the aorta presents slight dilatations, the aortic sinuses (sinuses of Valsalva ), which are larger than those at the origin of the pulmonary artery.
    • 69. aorta w/ semilunar valves
    • 70. aortic valve
    • 71.
      • trabeculæ carneæ
      • : three kinds, like those upon the right side, but are more numerous, especially at the apex, and upon the posterior wall of the ventricle.
      • papillary muscles
      • : two in number, of large size, and end in rounded extremities from which the chordæ tendineæ arise.
      • chordæ tendineæ
      • : from each papillary muscle are connected to both cusps of the bicuspid valve.
    • 72. gross anatomy oblique view
    • 73.
      • Ventricular Septum (interventricular septum)
      • ~ the greater portion is thick and muscular and constitutes the muscular ventricular septum.
      • ~ its upper and posterior part, which separates the aortic vestibule from the lower part of the right atrium and upper part of the right ventricle, is thin and fibrous, and is termed the membranous ventricular septum .
      • An abnormal communication may exist between the ventricles at this part owing to defective development of the membranous septum.
    • 74. ventricular septum
    • 75. base of the ventricles
    • 76.
      • Vessels and Nerves.
      • — The arteries supplying the heart are :
      • the right and left coronary from the aorta;
      • the veins end in the right atrium.
      • _The lymphatics end in the thoracic and right lymphatic ducts.
      • _The nerves are derived from the cardiac plexus , which are formed partly from the vagi, and partly from the sympathetic trunks. They are freely distributed both on the surface and in the substance of the heart.
    • 77.
      • THE ARTERIES
      • 1.The Pulmonary Artery
      • ~ conveys the venous blood from the right ventricle of
      • the heart to the lungs
      • ~ a short, wide vessel arising from the conus
      • arteriosus of the right ventricle
      • ~ divides, about the level of the fibrocartilage between
      • the 5 th & 6th thoracic vertebræ , into R and L
      • branches
      • ~ the whole of this vessel is contained within the
      • pericardium
      • ~ enclosed with the ascending aorta in a single tube of
      • the visceral layer of the serous pericardium.
    • 78.
      • ~ branches:
      • R branch
      • : longer and larger than the left, runs horizontally to the right, behind the ascending aorta and superior vena cava and in front of the right bronchus , to the root of the right lung, where it divides into two branches . The lower and larger of these goes to the middle and lower lobes of the lung; the upper and smaller is distributed to the upper lobe .
      • Left branch
      • : shorter and somewhat smaller than the right, passes horizontally in front of the descending aorta and left bronchus to the root of the left lung, where it divides into two branches , one for each lobe of the lung.
      • : connected above to the concavity of the aortic arch by the ligamentum arteriosum
    • 79. ligamentum arteriosum
    • 80. ligamentum arteriosum
      • ligamentum arteriosum- remnant of ductus arteriosus; connects left pulmonary a. near origin with undersurface of aortic arch
    • 81.
      • 2. The Aorta
      • ~ the main trunk of a series of vessels which convey the oxygenated blood to the tissues of the body.
      • ~ described in several portions, viz., the ascending aorta , the arch of the aorta , and the descending aorta , which last is again divided into the thoracic and abdominal aortæ.
      • Ascending Aorta
      • - commences at the upper part of the base of the L ventricle, passes obliquely upward, forward, and to the right, in the direction of the heart’s axis, describing a slight curve in its course, and being situated, about 6 cm. behind the posterior surface of the sternum.
      • : at the union of the ascending aorta with the aortic arch the caliber of the vessel is increased, owing to a bulging of its right wall. This dilatation is termed the bulb of the aorta
      • ~ the only branches of the ascending aorta are the two coronary arteries which supply the heart.
    • 82. aortic opening
    • 83. openings of R & L coronary arteries
    • 84.
      • Right Coronary Artery
      • : arises from the right anterior aortic sinus
      • : passes at first between the conus arteriosus and the right auricle and then runs in the right portion of the coronary sulcus
      • : continued to the apex of the heart as the posterior descending branch
      • : gives off a large marginal branch which follows the acute margin of the heart and supplies branches to both surfaces of the right ventricle . It also gives twigs to the right atrium and to the part of the left ventricle which adjoins the posterior longitudinal sulcus.
    • 85. R coro a.
    • 86. R marginal a.
    • 87.
      • Left Coronary Artery
      • : larger than the right
      • : arises from the left anterior aortic sinus and divides into:
      • a) anterior descending branch
      • - passes into the anterior longitudinal sulcus
      • - gives branches to both ventricles
      • b) circumflex branch
      • - runs as far as the posterior longitudinal sulcus
      • - gives branches to the left atrium and ventricle
      • There is a free anastomosis between the minute branches of the two coronary arteries in the substance of the heart.
    • 88. L coro a
    • 89. LAD
    • 90. circumflex a.
    • 91. L ant view
    • 92. coronary arteries Lat view
    • 93.
      • LAD (40-50%) Anterior wall of L ventricle
      • Anterior portion of ventricular
      • septum
      • Apex circumferentially
      • RCA (30-40%) Inferior-posterior wall of L vent
              • Posterior portion of ventricular
              • septum
              • Inferior-posterior R vent free
              • wall in some cases
      • LCX (15-20%) Lateral wall of L vent except
      • at apex
    • 94.
      • Arch of the Aorta
      • : begins at the level of the upper border of the 2nd R costal cartilage , and runs at first upward, backward, and to the left in front of the trachea and finally passes downward on the left side of the body of the 4th thoracic vertebra, at the lower border of which it becomes continuous with the descending aorta.
      • : the branches are three in number:
      • the innominate (brachiocephalic)
      • the left common carotid
      • the left subclavian
    • 95. imaging of the heart
    • 96.
      • Amazing Heart Facts
      • Sure, you know how to steal hearts, win hearts, and break hearts. But how much do you really know about your heart and how it works? Read on to your heart's content!
      • Put your hand on your heart. Did you place your hand on the left side of your chest? Many people do, but the heart is actually located almost in the center of the chest, between the lungs. It's tipped slightly so that a part of it sticks out and taps against the left side of the chest, which is what makes it seem as though it is located there.
      • Hold out your hand and make a fist. If you're a kid, your heart is about the same size as your fist, and if you're an adult, it's about the same size as two fists.
      • Your heart beats about 100,000 times in one day and about 35 million times in a year. During an average lifetime, the human heart will beat more than 2.5 billion times.
      • Give a tennis ball a good, hard squeeze. You're using about the same amount of force your heart uses to pump blood out to the body. Even at rest, the muscles of the heart work hard--twice as hard as the leg muscles of a person sprinting.
    • 97.
      • Feel your pulse by placing two fingers at pulse points on your neck or wrists. The pulse you feel is blood stopping and starting as it moves through your arteries. As a kid, your resting pulse might range from 90 to 120 beats per minute. As an adult, your pulse rate slows to an average of 72 beats per minute.
      • The aorta, the largest artery in the body, is almost the diameter of a garden hose. Capillaries, on the other hand, are so small that it takes ten of them to equal the thickness of a human hair.
      • Your body has about 5.6 liters (6 quarts) of blood. This 5.6 liters of blood circulates through the body three times every minute. In one day, the blood travels a total of 19,000 km (12,000 miles)--that's four times the distance across the US from coast to coast.
      • The heart pumps about 1 million barrels of blood during an average lifetime--that's enough to fill more than 3 super tankers.
      • lub-DUB, lub-DUB, lub-DUB. Sound familiar? If you listen to your heart beat, you'll hear two sounds. These "lub" and "DUB" sounds are made by the heart valves as they open and close.
    • 98. The End