General Anatomy 5

Thoracic cavity
 Cardiovascular System
• The heart and circulatory system make up
cardiovascular system.
• The heart works as a pump that pushes
blood to the organs, tissues & cells.
• Blood delivers oxygen and nutrients to
every cell and removes the CO2 and waste
products made by those cells.
• Blood is carried from the heart to the rest
of the body through arteries, arterioles,
and capillaries & is returned to the heart
through venules and veins.
• If all the vessels of this network were laid
end to end, they would extend for about
96,500 km, which is enough to
circle our planet more than twice!
 The Heart
• The heart is a hollow
muscular organ.
• Weighs between 200-425g.
• By the end of a long life, a
person's heart may have beat
more than 3.5 billion times.
• In fact, each day, the average
heart beats 100,000 times,
pumping about 2,000 gallons
(7,571 liters) of blood.
 Size, shape & location
• The heart is a little larger than
the size of your fist &
somewhat pyramid shaped.
• lies within the pericardium in
the mediastinum between the
lungs in the middle of the
chest, behind and slightly to
the left of sternum.
• It is connected at its base to
the great blood vessels but
otherwise lies free within the
pericardium.
 The pericardium
• A fibroserous sac that encloses
the heart and the roots of the
great vessels.
• lies within the middle
mediastinum.
➢ Posterior to the body of sternum
& the 2nd-6th costal cartilages.
➢ Anterior to the 5th-8th thoracic
vertebrae.
➢ It restrict excessive movements
of the heart & serves as a
lubricated container. 5
 Fibrous Pericardium
• It is the strong fibrous part of the
sac.
• It is firmly attached to:
➢ The central tendon of the
diaphragm (below).
➢ The outer coats of the great
blood vessels passing through it.
➢ To the sternum (in front) by the
sternopericardial ligaments.

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 Serous Pericardium
• lines the fibrous pericardium and coats
the heart.
• Divided into parietal & visceral layers
➢ The visceral layer is closely applied to
the heart “epicardium”.
➢ The parietal layer lines the fibrous
pericardium and is reflected around
the roots of the great vessels.
• The pericardial cavity is a slitlike space
between the parietal & visceral layers.
• Normally, the cavity contains a small
amount of fluid (50 mL) the pericardial
fluid, which acts as a lubricant. 7
 Nerve Supply of the Pericardium
• The fibrous pericardium and
the parietal layer of the serous
pericardium are supplied by
the phrenic nerves.
• The visceral layer of the
serous pericardium is
innervated by branches of the
sympathetic trunks and the
vagus nerves.

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 Borders of the Heart
• The right border is formed by
the right atrium.
• The left border by the left
atrium and below by the left
ventricle.
• The lower border is formed
mainly by the right ventricle and
the right atrium.
• These borders are important to
recognize when examining a
radiograph of the heart
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 Structure of the Heart
• The walls of the heart are
composed of:
• The epicardium which is the
serous pericardium covers
the heart externally.
• The Myocardium the cardiac
muscle.
• The endocardium a layer of
endothelium that lines
internally.
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 Structure of the Heart
• The atrial portion of the heart
has relatively thin walls.
• It is divided by the atrial
(interatrial) septum into the
right and left atria.
• The ventricular portion of the
heart has thick walls.
• It is divided by the ventricular
(interventricular) septum into
the right and left ventricles.

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 External Anatomy
❑ 4 chambers
➢ The right and left atria
➢ The right & left ventricles
❑ Auricles
❑ Major veins
➢ Superior vena cava
➢ Pulmonary veins
❑ Major arteries
➢ Aorta
➢ Pulmonary trunk
 Right Atrium
• Consists of a main cavity & a small
outpouching, the auricle.
Openings into the Right Atrium
➢ The superior vena cava opens into
the upper part of the right atrium.
• It returns the blood from the upper
half of the body. it has no valve
➢ The inferior vena cava opens into
the lower part of the right atrium.
• It returns the blood from the lower
half of the body. it has a
nonfunctioning valve
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 Right Atrium
➢ The coronary sinus, which drains
most of the blood from the heart
wall.
• It is guarded by a nonfunctioning
valve.
➢ The Right atrioventricular orifice
is guarded by the tricusped valve.
➢ Many small orifices of small veins
also drain the wall of the heart and
open directly into the right atrium.

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 Right Ventricle
• The walls of the right ventricle
are much thicker than those
of the right atrium.
• The right ventricle
communicates with:
➢ The right atrium through the
atrioventricular orifice.
➢ The pulmonary trunk through
the pulmonary orifice.

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 The Tricuspid Valve
The tricuspid valve guards the Right
atrioventricular orifice
• It consists of three cusps
(anterior, septal, posterior)
• The bases of the cusps are
attached to the fibrous ring of the
skeleton of the heart
• The free edges are attached to
the chordae tendineae.
• The chordae tendineae connect
the cusps to the papillary
muscles. 16
 The Pulmonary Valve
The pulmonary valve guards the
pulmonary orifice
• It consists of three semilunar
cusps.
• The lower margins and sides
of each cusp are attached to
the arterial wall.
• No chordae or papillary
muscles are associated with
these valve cusps.
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 Left Atrium
• The left atrium consists of a
main cavity & a left auricle.
• The left atrium is situated
behind the right atrium.
Openings into the Left Atrium
• The left atrioventricular orifice
is guarded by the mitral valve.
• The four pulmonary veins,(two
from each lung), open through
the posterior wall and have no
valves.
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 Left Ventricle
• The walls of the left ventricle are
three times thicker than those of
the right ventricle.
• The left intraventricular blood
pressure is 6 times higher than
that inside the right ventricle.
• It communicates with:
➢ The left atrium through the
atrioventricular orifice.
➢ The aorta through the aortic
orifice. 20
 The mitral valve
• The mitral valve guards the
left atrioventricular orifice.
• It consists of two cusps,
(anterior and posterior)
• They have a structure
similar to that of the cusps
of the tricuspid valve.

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 Aortic Valve
• The aortic valve guards the aortic
orifice.
• It is similar in structure to the
pulmonary valve
• The three cusps are the right
coronary, left coronary, and
posterior (noncoronary).
• Behind each cusp the aortic wall
bulges to form an aortic sinus.

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Arterial Supply of the Heart
• The arterial supply of the
heart is provided by:
➢ The right coronary artery.
➢ The left coronary artery.
• They arise from the ascending
aorta immediately above the
aortic valve.
• The coronary arteries and
their major branches are
distributed over the surface
of the heart.
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 Coronary Artery Anastomoses
• Collateral circulation are
anastomoses between the terminal
branches of the right and left
coronary arteries
• They are usually not large enough to
provide an adequate blood supply to
the cardiac muscle.
• A sudden block of one of the larger
branches of either coronary artery
usually leads to myocardial death
(myocardial infarction), although
sometimes the collateral circulation is
enough to sustain the muscle.
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Venous Drainage of the Heart
• Blood from the heart wall
drains through the coronary
sinus which is a continuation
of the great cardiac vein.
• The small and middle cardiac
veins are tributaries of the
coronary sinus.
• The remainder of the blood is
returned by the anterior
cardiac vein.

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Large Arteries of the Thorax
▪Aorta
▪Pulmonary Trunk

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 The Aorta
• It is the main arterial trunk that
delivers oxygenated blood from
the left ventricle of the heart to
the tissues of the body.
• It is divided for purposes of
description into the following
parts:
➢ Ascending aorta.
➢ Arch of the aorta.
➢ Descending thoracic aorta.
➢ Abdominal aorta.
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 Ascending Aorta
• lies within the fibrous pericardium,
begins at the base of the left
ventricle.
• It runs upward and forward, behind
the right half of the sternum.
• Becomes continuous with the arch of
the aorta at the level of the sternal
angle.
• At its root it possesses three bulges,
the sinuses of the aorta.
Branches
➢ The right coronary artery arises from
the right aortic sinus.
➢ The left coronary artery arises from
the left aortic sinus . 28
 Arch of the Aorta
• It is a continuation of the ascending
aorta, lies behind the manubrium sterni
• It arches upward, backward to become
continuous with the descending aorta.
Branches
❑ The brachiocephalic artery arises from
the convex surface of the aortic, passes
upward and divides into:
• The right subclavian artery.
• The right common carotid artery.
❑ The left common carotid artery.
❑ The left subclavian artery.
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 Descending Thoracic Aorta
• Begins as a continuation of the arch of the
aorta & runs downward in the posterior
mediastinum, in the anterior surface of the
vertebral column.
• At the level of the 12th thoracic vertebra, it
passes behind the diaphragm to become
continuous with the abdominal aorta.
Branches
➢ Posterior intercostal arteries : to the lower
9 intercostal spaces on each side.
➢ Subcostal arteries: on each side, run along
the lower border of the 12th rib to enter
the abdominal wall.
➢ Pericardial, esophageal, and bronchial
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arteries.
 Pulmonary Trunk
• It conveys deoxygenated blood from the
right ventricle to the lungs.
• It leaves the upper part of the right
ventricle .
• It runs upward, backward, and to the
left terminates in the concavity of the
aortic arch by dividing into right and left
pulmonary arteries.
• It is enclosed in the fibrous pericardium
together with the ascending aorta.
Branches
• The right pulmonary artery which enter
the root of the right lung.
• The left pulmonary artery which enter
the root of the left lung. 31
Large Veins of the Thorax
❑Brachiocephalic Veins
(right and left).
❑Superior Vena Cava.
❑Azygos Veins.
❑Inferior Vena Cava.
❑Pulmonary Veins.

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Brachiocephalic Veins (right & left)
• They formed at the root of
the neck by the union of:
➢ The subclavian
➢ The internal jugular veins .
• Both vens joined to form
the superior vena cava.

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 Superior Vena Cava
• It is formed by the union of
the two brachiocephalic
veins.
• It contains all the venous
blood from the head and
neck and both upper limbs.
• It passes downward to end
in the right atrium of the
heart.

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 Inferior Vena Cava
• The inferior vena cava
pierces the central tendon
of the diaphragm opposite
the 8th thoracic vertebra
and almost immediately
enters the lowest part of
the right atrium.

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 Pulmonary Veins
• Two pulmonary veins leave
each lung carrying
oxygenated blood .

• They drain into the left

atrium of the heart .

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➢ The trachea is a mobile cartilaginous and membranous tube .
➢ It begins in the neck as a continuation of the larynx at the
lower border of the cricoid cartilage at the level of the 6th
cervical vertebra. It descends in the midline of the neck.
➢ In the thorax, the trachea ends below at the carina by dividing
into right and left principal (main) bronchi at the level of the
sternal angle.
➢ In adults, the trachea is about 11.25 cm long and 2.5 cm in
diameter .
➢ The fibroelastic tube is kept patent by the presence of U-
shaped bars (rings) of hyaline cartilage embedded in its wall.
➢ The posterior free ends of the cartilage are connected by
smooth muscle, the trachealis muscle.
Anatomy Of Trachea
➢ The trachea bifurcates behind
the arch of the aorta into the
right and left principal (primary
or main) bronchi.
➢ The bronchi divide
dichotomously, giving rise to
several million terminal
bronchioles that terminate in
one or more respiratory
bronchioles.
➢Each respiratory bronchiole divides into 2 to
11 alveolar ducts that enter the alveolar sacs.
➢ The alveoli arise from the walls of the sacs as
diverticula.
❖ The right principal (main) bronchus:
a) Is wider, shorter, and more vertical than the left
and is about 2.5 cm long.
b) Before entering the hilum of the right lung, the
principal bronchus gives off the superior lobar
bronchus. On entering the hilum, it divides into a
middle and an inferior lobar bronchus.

❖ The left principal (main) bronchus:

a) Is narrower, longer, and more horizontal than the
right and is about 2 in. (5 cm) long. It passes to the
left below the arch of the aorta and in front of the
esophagus.
b) On entering the hilum of the left lung, the principal
bronchus divides into a superior and an inferior
lobar bronchus.
➢ During life, the right and left lungs are soft and spongy
and very elastic.
➢ In the child, they are pink. With age, they become dark
and mottled because of the inhalation of dust particles
that become trapped in the phagocytes of the lung.
➢ The lungs are situated so that one lies on each side of the
mediastinum. They are separated from each other by the
heart and great vessels and other structures in the
mediastinum.
➢ The lung has a concave mediastinal surface, which is
molded to the pericardium and other mediastinal
structures . At about the middle of this surface is the
hilum, a depression in which the bronchi, vessels, and
nerves that form the root enter and leave the lung.
❖ Right Lung:
✓ The right lung is slightly larger than the
left lung.
✓ Is divided by the oblique and horizontal
fissures into three lobes:
The upper, middle, and lower lobes.
✓ The middle lobe is thus a small
triangular lobe bounded by the
horizontal and oblique fissures.

❖ Left Lung:
✓ The left lung is divided by a similar
oblique fissure into two lobes: the
upper and lower lobes . There is no
horizontal fissure in the left lung.
❖Each pleura has two parts:
➢ Parietal layer, which lines the thoracic wall, covers the
thoracic surface of the diaphragm and the lateral aspect of
the mediastinum and extends into the root of the neck to
line the undersurface of the suprapleural membrane at the
thoracic outlet.

➢ Visceral layer, which completely covers the outer surfaces

of the lungs and extends into the depths of the interlobar
fissures.

➢ The parietal and visceral layers of pleura are separated

from one another by a slitlike space, the pleural cavity.

➢ The pleural cavity normally contains a small amount of

tissue fluid, the pleural fluid, which covers the surfaces of
the pleura as a thin film and permits the two layers to
move on each other with the minimum of friction.
 Lymphatic System
The lymphatic system consists of lymphatic
tissues and lymphatic vessels.
• Lymphatic tissues are a type of connective
tissue that contains large numbers of
lymphocytes.
➢ Lymphatic tissue is: the thymus, the
lymph nodes, the spleen, and the
lymphatic nodules.
➢ Lymphatic tissue is essential for the
immunologic defenses of the body.
• Lymphatic vessels are tubes that assist the
cardiovascular system in the removal of
tissue fluid from the tissue spaces of the
body; the vessels then return the fluid to
the blood. 45
 Lymphatic System
• Lymphatic vessels are found in all
tissues and organs of the body
EXCEPT the CNS, the eyeball, the
internal ear, the epidermis of the
skin, the cartilage, and the bone.
• Lymph is the tissue fluid once it has
entered a lymphatic vessel.
• Lymph capillaries are a network of
fine vessels that drain lymph from
the tissues.
• Before lymph is returned to the
bloodstream, it passes through at
least one lymph node. 46
 Lymphatic System
• The lymph vessels that carry
lymph to a lymph node referred
to as afferent vessels.
• Those that transport it away
from a node are efferent
vessels.
• The lymph reaches the
bloodstream at the root of the
neck by large lymph vessels
called the right lymphatic duct
and the thoracic duct.
 Thoracic Duct
• It conveys to the blood all lymph from the
lower limbs, pelvic cavity, abdominal
cavity, left side of the thorax, and left side
of the head, neck, and left arm.
• It begins below in the abdomen as a
dilated sac, the cisterna chyli.
• It ascends through the aortic opening in
the diaphragm.
• It gradually crosses the median plane
behind the esophagus and then runs
upward along the left edge of the
esophagus to enter the root of the neck.
• It turns downward to end in the beginning
of the left brachiocephalic vein.
• At the root of the neck, the thoracic duct
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receives the left jugular, subclavian.
 The right lymphatic duct
• It is a union of the
right jugular,
subclavian, and
bronchomediastinal
trunks, which drain:
• the right side of the
head and neck, the
right upper limb, and
the right side of the
thorax, respectively.

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