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pericardium and heart topography with dr. Ameera Al-Humidi.pptx

this lecture describes the pericardium and heart chambers and valves including input and output openings with some characteristics of each chamber

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PERICARDIUM AND HEART TOPOGRAPHY
1
PERICARDIUMAND HEART
TOPOGRAPHY
PERICARDIUM AND HEART TOPOGRAPHY
2
PERICARDIUM AND HEART TOPOGRAPHY
3
✓Describe the shape of heart
✓ Describe the heart chambers
✓List the orifices of the heart
✓ Describe innervation of the heart
✓ describe conduction system of Heart
PERICARDIUM AND HEART TOPOGRAPHY
4
FUNCTIONS of CVS
It is a transportation system which uses the blood as the
transport vehicle.
It carries oxygen, nutrients, cell wastes, hormones and many
other substances vital for body homeostasis.
The force to move the blood around the body is provided by
the beating Heart
PERICARDIUM AND HEART TOPOGRAPHY
5
FUNCTIONS of CVS
PERICARDIUM AND HEART TOPOGRAPHY
6
Components of CVS

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pericardium and heart topography with dr. Ameera Al-Humidi.pptx

  • 1. PERICARDIUM AND HEART TOPOGRAPHY 1
  • 3. PERICARDIUM AND HEART TOPOGRAPHY 3 ✓Describe the shape of heart ✓ Describe the heart chambers ✓List the orifices of the heart ✓ Describe innervation of the heart ✓ describe conduction system of Heart
  • 4. PERICARDIUM AND HEART TOPOGRAPHY 4 FUNCTIONS of CVS It is a transportation system which uses the blood as the transport vehicle. It carries oxygen, nutrients, cell wastes, hormones and many other substances vital for body homeostasis. The force to move the blood around the body is provided by the beating Heart
  • 5. PERICARDIUM AND HEART TOPOGRAPHY 5 FUNCTIONS of CVS
  • 6. PERICARDIUM AND HEART TOPOGRAPHY 6 Components of CVS
  • 7. PERICARDIUM AND HEART TOPOGRAPHY 7 Pericardium
  • 9. PERICARDIUM AND HEART TOPOGRAPHY 9 Pericardium The pericardium is a conical sac that surrounds the heart and the roots of the great blood vessels
  • 10. PERICARDIUM AND HEART TOPOGRAPHY 10
  • 11. PERICARDIUM AND HEART TOPOGRAPHY 11 Pericardium
  • 12. PERICARDIUM AND HEART TOPOGRAPHY 12
  • 13. PERICARDIUM AND HEART TOPOGRAPHY 13 Pericardium
  • 14. PERICARDIUM AND HEART TOPOGRAPHY 14
  • 15. PERICARDIUM AND HEART TOPOGRAPHY 15 Pericardial ligaments / Attachments Above: Its apex is fused with the walls of the external coat of ascending aorta and pulmonary trunk Below: Its base is attached to the central tendon of the diaphragm In front: It is attached to the back of the sternum.
  • 16. PERICARDIUM AND HEART TOPOGRAPHY 16
  • 17. PERICARDIUM AND HEART TOPOGRAPHY 17 Pericardial ligaments / Attachments
  • 18. PERICARDIUM AND HEART TOPOGRAPHY 18
  • 19. PERICARDIUM AND HEART TOPOGRAPHY 19 Pericardial Sinuses The pericardial sinuses are impressions in the pericardial sac formed between the points where great vessels enter it.
  • 20. PERICARDIUM AND HEART TOPOGRAPHY 20 Pericardial Sinuses
  • 21. PERICARDIUM AND HEART TOPOGRAPHY 21 Pericardial Sinuses
  • 22. PERICARDIUM AND HEART TOPOGRAPHY 22
  • 23. PERICARDIUM AND HEART TOPOGRAPHY 23 Arterial supply of pericardium 1. Fibrous and parietal pericardia supplied by the branches of: i. Internal thoracic arteries ii. Pericardial branches of descending thoracic aorta iii. Musculophrenic arteries. 2. Visceral layer supplied by the coronary arteries.
  • 24. PERICARDIUM AND HEART TOPOGRAPHY 24 Venous drainage of pericardium 1. Fibrous and parietal pericardial drain into: i. Azygos system. ii. Internal thoracic vein. 2. Visceral layer drain into the coronary sinus.
  • 25. PERICARDIUM AND HEART TOPOGRAPHY 25 Lymphatic Drainage of pericardium Lymph vessels drain into the mediastinal lymph nodes and some directly enter into the thoracic duct.
  • 26. PERICARDIUM AND HEART TOPOGRAPHY 26 Nerve supply of pericardium 1. Fibrous and parietal pericardial: Phrenic nerves. 2. Visceral layer: i. Parasympathetic—vagus nerves. ii. Sympathetic nerves via the coronary plexus.
  • 27. PERICARDIUM AND HEART TOPOGRAPHY 27
  • 28. PERICARDIUM AND HEART TOPOGRAPHY 28 Structures Piercing the Fibrous Pericardium i. Ascending aorta ii. Superior vena cava iii. Inferior vena cava iv. Right and left pulmonary arteries v. Four pulmonary veins (2 from each lung).
  • 29. PERICARDIUM AND HEART TOPOGRAPHY 29 Pericardium
  • 30. PERICARDIUM AND HEART TOPOGRAPHY 30
  • 31. PERICARDIUM AND HEART TOPOGRAPHY 31
  • 32. PERICARDIUM AND HEART TOPOGRAPHY 32
  • 33. PERICARDIUM AND HEART TOPOGRAPHY 33 The Heart
  • 34. PERICARDIUM AND HEART TOPOGRAPHY 34 The Heart It lies in the middle mediastinum. It consists of 4 chambers: • 2 atria (right& left) that receive blood • 2 ventricles (right& left) that pump blood.
  • 35. PERICARDIUM AND HEART TOPOGRAPHY 35
  • 36. PERICARDIUM AND HEART TOPOGRAPHY 36 The Heart
  • 37. PERICARDIUM AND HEART TOPOGRAPHY 37
  • 38. PERICARDIUM AND HEART TOPOGRAPHY 38 The Heart Male - 280 to 340 gm (Average - 300 gm) Female - 230 to 280 gm (Average - 250 gm)
  • 39. PERICARDIUM AND HEART TOPOGRAPHY 39 The Heart The Heart is somewhat pyramidal in shape, having: 1. Apex 2. Sterno-costal (anterior surface) 3. Diaphragmatic (inferior surface) 4. Base (posterior surface)
  • 40. PERICARDIUM AND HEART TOPOGRAPHY 40
  • 41. PERICARDIUM AND HEART TOPOGRAPHY 41 The Heart 1- Apex Directed downwards, forwards and to the left. It is formed by the left ventricle. Lies at the level of left 5TH intercostal space (the same level of the nipple); 3.5 inch from midline.
  • 42. PERICARDIUM AND HEART TOPOGRAPHY 42
  • 43. PERICARDIUM AND HEART TOPOGRAPHY 43 The Heart Note The base of the heart is called the base because the heart is pyramid shaped; the base lies opposite to the apex. The heart does not rest on its base; it rests on its diaphragmatic (inferior) surface.
  • 44. PERICARDIUM AND HEART TOPOGRAPHY 44 The Heart 2- Sterno-Costal (Anterior) Surface This surface is formed mainly by: the right atrium and the right ventricle (we said mainly because there is also a little part by of the left ventricle).
  • 45. PERICARDIUM AND HEART TOPOGRAPHY 45 The Heart
  • 46. PERICARDIUM AND HEART TOPOGRAPHY 46 The Heart 2- Sterno-Costal (Anterior) Surface Divided by coronary (atrio-ventricular) groove (which lodges the right coronary artery) into : 1. Atrial part: formed mainly by right atrium. 2. Ventricular part : the right 2/3 is formed by right ventricle, while the left 1/3 is formed by left ventricle. So, it is also formed of some of the left ventricle
  • 47. PERICARDIUM AND HEART TOPOGRAPHY 47 The Heart 2- Sterno-Costal (Anterior) Surface The 2 ventricles are separated by anterior interventricular groove, which lodges: • Anterior interventricular artery (branch of left coronary) • Great cardiac vein
  • 48. PERICARDIUM AND HEART TOPOGRAPHY 48 The Heart
  • 49. PERICARDIUM AND HEART TOPOGRAPHY 49 The Heart
  • 50. PERICARDIUM AND HEART TOPOGRAPHY 50 The Heart 3- Diaphragmatic (Inferior) Surface Formed by the 2-ventricles, mainly left ventricle (left 2/3). o Slightly concave as it rests on diaphragm. o Directed inferiorly & backward. Separated from base of heart by posterior part of coronary sulcus.
  • 51. PERICARDIUM AND HEART TOPOGRAPHY 51 The Heart 3- Diaphragmatic (Inferior) Surface The 2-ventricles are separated by posterior interventricular groove which lodges: • Posterior interventricular artery • Middle cardiac vein.
  • 52. PERICARDIUM AND HEART TOPOGRAPHY 52 The Heart 4- Base of the Heart (posterior surface) It is formed by the 2 atria, mainly left atrium, into which open the 4 pulmonary veins (2 right and 2 left). It is directed backwards. Lies opposite middle thoracic vertebrae (5-7) (T5, T6, T7)
  • 53. PERICARDIUM AND HEART TOPOGRAPHY 53 The Heart 4- Base of the Heart (posterior surface) Is separated from the vertebral column by: • descending aorta, • esophagus and • oblique sinus of pericardium (will be discussed later) o Bounded inferiorly by posterior part of coronary sulcus , which lodges the coronary sinus
  • 54. PERICARDIUM AND HEART TOPOGRAPHY 54 Borders of the Heart
  • 55. PERICARDIUM AND HEART TOPOGRAPHY 55 Chambers of the Heart The heart is divided by vertical septa into four chambers: • the right and left atria • the right and left ventricles. o The right atrium lies anterior to the left atrium, and the right ventricle lies anterior to the left ventricle
  • 56. PERICARDIUM AND HEART TOPOGRAPHY 56 Chambers of the Heart
  • 57. PERICARDIUM AND HEART TOPOGRAPHY 57 Right Atrium The right atrium consists of a main cavity and a small out pouching, the auricle (upward protrusion resembling ear). o On the outside of the heart at the junction between the right atrium and the right auricle is a vertical groove, the sulcus terminalis, which on the inside forms a ridge, the crista terminalis.
  • 58. PERICARDIUM AND HEART TOPOGRAPHY 58 Right Atrium The right atrium consists of a main cavity and a small out pouching, the auricle (upward protrusion resembling ear). o On the outside of the heart at the junction between the right atrium and the right auricle is a vertical groove, the sulcus terminalis, which on the inside forms a ridge, the crista terminalis.
  • 59. PERICARDIUM AND HEART TOPOGRAPHY 59 Right Atrium Cavity Crista terminalis divides right atrium into: 1. Anterior part: rough (because of muscles) and trabeculated by bundles of muscle fibres (musculi pectinati or pectinate muscle). 2. Posterior part (sinus venarum) is smooth.
  • 60. PERICARDIUM AND HEART TOPOGRAPHY 60 Right Atrium Cavity
  • 61. PERICARDIUM AND HEART TOPOGRAPHY 61 Right Atrium Cavity The interatrial septum carries an oval depression called Fossa ovalis. The margin of this depression is called Anulus ovalis
  • 62. PERICARDIUM AND HEART TOPOGRAPHY 62 The blood leaves right atrium to right ventricle via tricuspid valve Right Atrium Cavity
  • 63. PERICARDIUM AND HEART TOPOGRAPHY 63 The blood leaves right atrium to right ventricle via tricuspid valve Right Atrium Cavity
  • 64. PERICARDIUM AND HEART TOPOGRAPHY 64 Right Atrium (openings) 1- SVC (superior vena cava) : has no valve 2- IVC (inferior vena cave): guarded by a valve 3- Coronary sinus: has a well-defined valve 4- Right atrioventricular orifice lies anterior to IVC opening, it is surrounded by a fibrous ring which: gives attachment to the tricuspid valve 5- Small orifices of small veins
  • 65. PERICARDIUM AND HEART TOPOGRAPHY 65
  • 66. PERICARDIUM AND HEART TOPOGRAPHY 66 Right Ventricle Its wall is thinner than that of the left ventricle. Its wall contains projections called trabeculae carnae (irregular bands and bundles of muscle projecting from the inner surface). The right ventricle communicates with right atrium through right atrioventricular orifice & with pulmonary trunk through pulmonary orifice.
  • 67. PERICARDIUM AND HEART TOPOGRAPHY 67 Right Ventricle As the cavity approaches the pulmonary orifice it becomes funnel shaped, at which point it is referred to as the infundibulum(also known as conus arteriosus)
  • 68. PERICARDIUM AND HEART TOPOGRAPHY 68 Right Ventricle Large projections arise from the walls called papillary muscles : • Anterior papillary muscle • Posterior papillary muscle • Septal papillary muscle. (left ventricle has no septal papillary muscle) (septal means between the 2 ventricles: it is connected to the interventricular septum) Each papillary muscle is attached to the cusps of tricuspid valve by tendinous threads called chordae tendinae
  • 69. PERICARDIUM AND HEART TOPOGRAPHY 69 Right Ventricle
  • 70. PERICARDIUM AND HEART TOPOGRAPHY 70 Right Ventricle Blood leaves the right ventricle to pulmonary trunk through pulmonary orifice
  • 71. PERICARDIUM AND HEART TOPOGRAPHY 71 Right Ventricle
  • 72. PERICARDIUM AND HEART TOPOGRAPHY 72
  • 74. PERICARDIUM AND HEART TOPOGRAPHY 74
  • 76. PERICARDIUM AND HEART TOPOGRAPHY 76
  • 77. PERICARDIUM AND HEART TOPOGRAPHY 77
  • 78. PERICARDIUM AND HEART TOPOGRAPHY 78 Right Atrio-Ventricular (Tricuspid) Orifice About one inch wide, admitting tips of 3 fingers(wider than left atrio-ventricular orifice) It has 3-cusps (anterior – posterior - septal or medial). The atrial surface (superior) of the cusps are smooth, while their ventricular surfaces (inferior) give attachment to the chordae tendinea.
  • 79. PERICARDIUM AND HEART TOPOGRAPHY 79 Pulmonary Orifice The valve is formed of 3 semilunar cusps : 2 anterior and one posterior which are concave superiorly and convex inferiorly. No chordae tendineae or papillary muscles are attached to these cusps.
  • 80. PERICARDIUM AND HEART TOPOGRAPHY 80 Left Atrium The left atrium communicates with the left ventricle through the left atrioventricular orifice. It forms the greater part of the base of heart. Its wall is smooth except for small musculi pectinati (pectinate = ( in the left auricle.
  • 81. PERICARDIUM AND HEART TOPOGRAPHY 81 Left Atrium Receives 4 pulmonary veins (2 left & 2 right) which have no valves. Sends blood to left ventricle through the left atrioventricular orifice which is guarded by mitral valve (Bicuspid valve).
  • 82. PERICARDIUM AND HEART TOPOGRAPHY 82 Left Atrium
  • 83. PERICARDIUM AND HEART TOPOGRAPHY 83 Left Atrium Quiz
  • 84. PERICARDIUM AND HEART TOPOGRAPHY 84 Left Ventricle Its wall is thicker than that of right ventricle. The wall of the left ventricle contains trabeculae carnae. It receives blood from left atrium through left atrio-ventricular orifice which is guarded by mitral valve (bicuspid) The blood leaves the left ventricle to the ascending aorta through the aortic orifice
  • 85. PERICARDIUM AND HEART TOPOGRAPHY 85 Left Ventricle The part of left ventricle leading to ascending aorta is called aortic vestibule. It also contains 2 large papillary muscles (anterior & posterior). They are attached by chordae tendinae to cusps of mitral valve.
  • 86. PERICARDIUM AND HEART TOPOGRAPHY 86 Left Ventricle
  • 87. PERICARDIUM AND HEART TOPOGRAPHY 87 Left Atrio-Ventricular (Mitral) Orifice Smaller than the right, admitting only tips of 2 fingers. Guarded by a mitral valve. Surrounded by a fibrous ring which gives attachment to the cusps of mitral valve.
  • 88. PERICARDIUM AND HEART TOPOGRAPHY 88 Left Atrio-Ventricular (Mitral) Orifice Mitral valve is composed of 2 cusps: • Anterior cusp : lies anteriorly and to right. • Posterior cusp : lies posteriorly and to left. o The atrial surfaces of the cusps are smooth, while ventricular surfaces give attachment to chordae tendinae.
  • 89. PERICARDIUM AND HEART TOPOGRAPHY 89 Aortic Orifice Surrounded by a fibrous ring which gives attachment to the cusps of aortic valve. Aortic valve is formed of 3 semilunar cusps which are similar to those of pulmonary valve, but the position of the cusps differs being one anterior and 2 posterior.
  • 90. PERICARDIUM AND HEART TOPOGRAPHY 90
  • 91. PERICARDIUM AND HEART TOPOGRAPHY 91 Aortic sinuses An aortic sinus, also known as the sinus of Valsalva, is one of the anatomic dilatations of the ascending aorta, which occurs just above the aortic valve. There are generally three aortic sinuses: one anterior and two posterior sinuses These widenings are between the wall of the aorta and each of the three cusps of the aortic valve
  • 92. PERICARDIUM AND HEART TOPOGRAPHY 92 Aortic Orifice
  • 93. PERICARDIUM AND HEART TOPOGRAPHY 93
  • 94. PERICARDIUM AND HEART TOPOGRAPHY 94 Aortic sinuses The two aortic sinuses that lie adjacent to the pulmonary trunk are called the right and left facing sinuses, the right facing sinus typically giving rise to the right coronary artery and the left facing sinus the left coronary artery The posterior aortic sinus usually gives rise to no vessels and is often known as the non-coronary sinus
  • 95. PERICARDIUM AND HEART TOPOGRAPHY 95 Nerve supply of the heart Autonomic Supply: by sympathetic & parasympathetic fibers via the cardiac plexus situated below arch of aorta. The sympathetic fibers arise from the cervical & upper thoracic (1, 2, 3, 4) ganglia of sympathetic trunks. The parasympathetic fibers arise from the vagus nerves. Sympathetic Fibers-accelerate heart rate but Parasympathetic Fibers- slow heart rate (constriction of coronary arteries)
  • 96. PERICARDIUM AND HEART TOPOGRAPHY 96 Nerve supply of the heart
  • 97. PERICARDIUM AND HEART TOPOGRAPHY 97 Conducting system of heart
  • 98. PERICARDIUM AND HEART TOPOGRAPHY 98
  • 99. PERICARDIUM AND HEART TOPOGRAPHY 99 Conduction system of the heart The beating of the heart is regulated by the intrinsic conduction (nodal) system. Its function is to ensure that the chambers of the heart contract in the proper rhythm and sequence The SA node is called the pacemaker of the heart, because it generates the impulse.
  • 100. PERICARDIUM AND HEART TOPOGRAPHY 100 Conduction system of the heart
  • 101. PERICARDIUM AND HEART TOPOGRAPHY 101 Blood circulation
  • 102. PERICARDIUM AND HEART TOPOGRAPHY 102 Blood circulation
  • 103. PERICARDIUM AND HEART TOPOGRAPHY 103
  • 104. PERICARDIUM AND HEART TOPOGRAPHY 104 chambers Left ventricle Left atrium Right ventricle Right atrium Characteristics The wall is thicker than that of right ventricle components Its wall contains 2 large papillary muscles ( anterior& posterior ). They are attached by chordae tendineae to cusps of mitral valve Its wall contains trabeculae carnae Its wall is smooth except for musculi pectinate in the left auricle Receives 4 pulmonary veins which have no valves Characteristics The wall is thinner than that of left ventricle Its wall contains trabeculae carnae components Papillary muscles Anterior Papillary muscles Posterior Papillary muscles Septal Papillary muscles Attached to the cusps of tricuspid valve by tendinous threads called chordae tendinea Consists of a main cavity and the auricle Sulcus terminalis which forms the crista terminalis that divide the atrium into Anterior part Posterior part The interatrial septum carries an oval depression called fossa ovalis Openings in right atrium SVC IVC Coronary sinus Right atrioventricular orifice Small orifices
  • 105. PERICARDIUM AND HEART TOPOGRAPHY 105 Orifices Aortic orifice Left atrioventricular (mitral) orifice The blood leaves the left ventricle to the ascending aorta through it Aortic valve is formed of 3 semilunar cusps ( 1 anterior and 2 posterior) The left atrium communicates with the left ventricle through it Mitral valve is compressed of 2 cusps( 1 anterior and 1 posterior). The atrial surface of the cusps are smooth while ventricular surface give attachment to chordae tendinea Pulmonary orifice Right atrioventricular (tricuspid) orifice The right ventricle communicates with pulmonary trunk through it The valve is formed of 3 semilunar cusps: 2 anterior and 1 posterior. No chorda tendinea or papillary muscles are attached to these cusps. The right ventricle communicates with right atrium through it It has 3 cusps (anteroposterior- septal or medial). The atrial surface of the cusps are smooth. While the ventricular surfaces give attachment to the chordae tendinea
  • 106. PERICARDIUM AND HEART TOPOGRAPHY 106 Nerve supply Postganglionic fibers Reach heart along- SAN, AVN, and nerve plexus around coronary arteries Cardiac plexus Sympathetic fibers parasympathetic fibers Arise from sympathetic trunk Accelerate heart rate Arise from vagus nerve Slow heart rate Conduction system Regulated by Intrinsic conduction nodal system Function Is to ensure that the chambers of the heart contact in proper rhythm and sequence Sinoatrial (SA) node peacemaker atrioventricular (AV) node atrioventricular (AV) bundle Purkinji fibers
  • 107. PERICARDIUM AND HEART TOPOGRAPHY 107 Shape Apex Base Sterno-costal Diaphragmatic -directed downward. -deviated to the left. -Formed by left ventricle. -At the level of 5th intercostal space 3.5 inch from midline -it is formed by the 2 atria. -mainly by left atrium. -it is directed backward. Apposite to the apex and the heart does not lie on its base This surface is formed mainly by the right atrium and the right ventricle Divided by coronary ( atrio- ventricular) groove into: 1-atrial part 2-ventricular part The coronary groove lodges: The right coronary artery The 2 ventricles forming the ventricular part are separated by anterior interventricular groove which lodges: 1-anterior interventricular artery 2-great cardiac vein. -Formed by the 2 ventricles mainly left ventricle. -slightly concave. -directed anterior and backward. -separated from the base of heart by coronary sulcus The 2 ventricles are separated by posterior interventricular groove which lodges: 1-posterior interventricular artery. 2-middle cardiac vein.
  • 108. 108 PERICARDIUM AND HEART TOPOGRAPHY Borders Upper border Right border Lower border Left border Formed by 2 atria and connected by descending aorta and pulmonary trunk Formed by right atrium Formed mainly by right ventricle and apical part of left ventricle. Formed mainly by left ventricle and auricle of left atrium.
  • 109. PERICARDIUM AND HEART TOPOGRAPHY 109
  • 110. PERICARDIUM AND HEART TOPOGRAPHY 110 Auscultation of Heart Valves
  • 111. PERICARDIUM AND HEART TOPOGRAPHY 111 Artificial Pacemaker
  • 112. PERICARDIUM AND HEART TOPOGRAPHY 112 Heart and lung transplantation
  • 113. PERICARDIUM AND HEART TOPOGRAPHY 113
  • 114. PERICARDIUM AND HEART TOPOGRAPHY 114
  • 115. PERICARDIUM AND HEART TOPOGRAPHY 115
  • 116. PERICARDIUM AND HEART TOPOGRAPHY 116
  • 117. PERICARDIUM AND HEART TOPOGRAPHY 117 Cardiac Tamponade
  • 118. PERICARDIUM AND HEART TOPOGRAPHY 118
  • 119. PERICARDIUM AND HEART TOPOGRAPHY 119
  • 120. PERICARDIUM AND HEART TOPOGRAPHY 120
  • 121. PERICARDIUM AND HEART TOPOGRAPHY 121
  • 123. PERICARDIUM AND HEART TOPOGRAPHY 123