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APE 02 – The Cardiovascular System - Anatomy Masterclass
Cardiology (St George's Hospital Medical School)
Studocu is not sponsored or endorsed by any college or university
APE 02 – The Cardiovascular System - Anatomy Masterclass
Cardiology (St George's Hospital Medical School)
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2. Anatomy Masterclass
Biomedical Science
1
APE 02 – The Cardiovascular System
• Heart: central pump of the circulatory system.
• Investigating the heart:
➢ Listening to heart valves
➢ Cardiograms
STATION 1: Whole heart with vessels of the upper body:
The Cardiac cycle: blue – systemic circulation/ green – pulmonary circulation
1) The heart cycle starts with the superior and inferior vena cava depositing deoxygenated blood
into right atrium
2) This gets pushed into right ventricle.
3) Blood pushed out of right ventricle to lungs via pulmonary artery, this is under low pressure, to
allow good gaseous exchange.
4) Blood gets oxygenated by diffusion → then comes back to heart and enters via four pulmonary
veins into left atrium.
5) From left atrium it is pumped into left ventricle
6) Finally pumped out of left ventricle under high pressure into aorta which supplies whole body
with oxygenated blood. Left ventricles has thick walls due to higher pressure generation to drive
blood through longer distances around the body via aorta.
Identify the aorta, superior and inferior vena cavae, pulmonary arteries and veins – finding both ends
are very hard to show in images so refer to 8How to use Biodigital for CVS session anatomy9 Document
for further guidance.
Surfaces of heart:
1. Anterior (or sternocostal) – Right ventricle.
2. base – Left atrium.
3. Inferior (or diaphragmatic) – Left and right ventricles.
4. Right pulmonary – Right atrium
5. Left pulmonary – Left ventricle.
Borders of heart:
• The left ventricle is the chamber forming the apex of the heart
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Valves
Deoxygenated blood from body → Superior and inferior Vena Cava → Right Atrium → tricuspid valve
→ Right Ventricles → Pulmonary (semilunar) valve → Pulmonary trunk → Pulmonary artery →
oxygenated blood → pulmonary veins → left atrium → Bicuspid (mitral) valve → left ventricles →
Aortic valve → Aorta → supplies all body
The right side of the heart
Right atrium
• Blood returning the heart through the inferior and superior vena cava enters the right atrium.
• Auricles (ear-like flaps) of the atrial walls: One auricle (atrial appendage) is attached left atrium and
right atrium.
• Purpose of auricles: increase capacity of atrium, and so also increase volume of blood that it is able
to contain.
• Some parts of the walls are rough, and some are smooth
• The lining of auricle is rough, the ridges being known as musculi pectinati,
• The lining of the rest of atrium is smooth. The parts are separated by the crista terminalis.
Normal Cardiac cycle
Deoxygenated blood from body → Superior and inferior Vena Cava → Right Atrium → tricuspid valve
→ Right Ventricles → Pulmonary (semilunar) valve → Pulmonary trunk → Pulmonary artery →
oxygenated blood → pulmonary veins → left atrium → Bicuspid (mitral) valve → left ventricles → Aortic
valve → Aorta → supplies all body
Foetal Cardiac cycle
• During fetal development, the foramen ovale allows blood to pass from the right atrium to left
atrium, bypassing the nonfunctional fetal lungs while the fetus obtains its oxygen from placenta.
• Fossa ovalis: a depression in right atrium at the level of the interatrial septum (wall between right
and left atrium). It is a remnant of a thin fibrous sheet that covered the foramen ovale during fetal
development.
Valve Cusps Location
Tricuspid 3 Between RA & RV
Bicuspid/ Mitral 2 Between LA & LV
Pulmonary (Semilunar) 3 At base of pulmonary artery
Aortic (semilunar) 3 At base of aorta
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Right ventricle
• Tricuspid valve: consists of three cusps (anterior, septal and posterior)
• There are strong fibrous cords - chordae tendinae - attached to cusps
• Those are attached to cone-shaped papillary muscles that project from ventricular walls.
• Papillary muscle relaxed → chordae tendinae is slack → valve is open
• When papillary contracted → chordae tendinae is taut → valve is closed
• Walls of right ventricular are thicker than right atrium but thinner than left ventricle.
• The wall of the right ventricle has a roughened and a smooth-walled part. The ridges of the rough
portion are the trabeculae carneae. The smooth part is the infundibulum (conus arteriosus) and
it leads to the pulmonary trunk.
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The left side of the heart
Left atrium:
• The left atrium receives 4 pulmonary veins, two from each lung
• Lining of it has muscular ridges
Left ventricles:
• Wall of LV is thicker compared to that of RV because it has to pump blood through aorta to rest
of body therefore pressure is very high.
• The interventricular septum bulges into the right ventricle. Why does the interventricular septum
bulge into the right ventricle and not into the left?
………………………………………………………………………………………………………………………………………………………..
• The left ventricle forms apex of heart. The pulsations of the apex beat are typically felt in fifth
intercostal space, in the midclavicular line (this is where the mitral valve is best heard too).
Bicuspid Valve
The coronary circulation
• Aortic valve has aortic sinuses (spaces) above them.
• The coronary arteries arise from two of these sinuses (anterior and left posterior).
• Find their ostia (openings) in the sinuses.
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• What do the coronary arteries supply? They supply tissues of heart wall
Artery Origins Major branches
Right coronary artery Ascending aorta marginal and right posterior
descending arteries (PDA, AKA
posterior interventricular artery)
Left coronary artery Ascending arota Left anterior descending (LAD,
AKA anterior interventricular)
and circumflex arteries.
• The venous drainage of the heart is via the great, middle, and small cardiac veins. The veins
converge on to the coronary sinus, a large vein that opens into the right atrium.
• With which coronary artery does each of the cardiac veins run?
Vein Travels with
Great Cardiac Vein Anterior Interventricular Coronary Artery
Middle Cardiac Vein Posterior (right) interventricular coronary artery
Small cardiac vein Marginal branch of the right coronary artery
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Blood vessels in the neck
Arch of the aorta gives rise to 3 major arteries:
1) Left subclavian
2) Left common carotid
a) internal carotid arteries
b) external carotid arteries
3) brachiocephalic trunk which divides to give:
- Right subclavian arteries
- Right common carotid – which bifurcates (splitting into
two), giving rise to:
a) internal carotid arteries → supplies the brain
b) external carotid arteries → supplies face and neck
Now identify the internal and external jugular veins.
• Internal jugular veins unite with subclavian veins → forming
brachiocephalic veins which unite to form→ superior vena cava.
Peripheral vessels
• Aorta bifurcates into two common iliac arteries (at L4)
• Each common iliac artery bifurcates into an external and an internal iliac artery.
➢ Internal iliac supplies the pelvis
➢ External iliac supplies the lower limb
Blood supply to the upper limb:
• subclavian arteries pass over 1st
rib → enter axilla (armpit) → renamed axillary arteries → medial
to biceps become brachial arties (used to take BP)→ in cubital fossa (see below) bifurcates into
ulnar and radial (radial pulse felt at wrist) arteries → palmar arch
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• cubital fossa: an area of transition between the anatomical arm and the forearm. Located as a
depression on the anterior surface of the elbow joint
• superficial veins of upper limb are quite variable
• median cubital vein → usually used by phlebotomists to take a blood sample
Arteries of the lower limb
• Aorta bifurcates into two common iliac arteries (at L4) → common iliac artery
bifurcates into an external and an internal iliac artery.
➢ Internal iliac supplies the pelvis
➢ External iliac → femoral artery () → distally
• Femoral artery is in mid-inguinal point, in femoral triangle, pulse can be
felt
• It runs between femoral nerve and femoral vein.
• Note that the order of neurovascular structures in the femoral triangle is:
nerve/artery/vein (lateral-medial).
Femoral artery path
• Aorta → common iliac arteries → external iliac artery → femoral artery → distally
gives off a deep branch that supplies anterior thigh muscles → then passes through
an opening in one of medial thigh muscles to enter popliteal fossa (blue circle
below) behind knee → At this point the artery is called the popliteal artery →
leaves popliteal fossa divides to form anterior and posterior tibial arteries.
• The popliteal artery and popliteal vein are in the middle of the popliteal fossa.
• a very large nerve that enters the popliteal fossa from the posterior thigh. This is
the sciatic nerve (which splits forming the tibial nerve)
• The posterior tibial artery can be palpated at medial malleolus.
• dorsalis pedis artery on dorsum of foot is continuation of anterior tibial artery.
• The posterior tibial and dorsalis pedis pulses are used to assess blood supply to the
lower limb.
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There are two major veins that provide superficial venous drainage of the lower limb,
1) short saphenous vein → drains into the popliteal vein
2) great saphenous vein → drains into the femoral vein in femoral triangle
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