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Pericardium & Heart

Thorax Unit
Lecture 5 & 6
‫ حيدر جليل السعسم‬.‫د‬

It is a fibroserous sac
enclosing heart and roots of
great vessels. Pericardium
lies within middle
mediastinum, posterior to
body of sternum and 2nd 6th costal cartilages and
anterior to 5th - 8th
thoracic vertebrae.
It is composed of two layers
A. Fibrous Pericardium
B. Serous Pericardium


Fibrous Pericardium
Fibrous pericardium is
strong fibrous part of the
sac. It is firmly attached
below to central tendon of
the diaphragm. It fuses with
outer coats of great blood
vessels passing through it
(aorta, pulmonary trunk,
superior and inferior
venae cavae, and
pulmonary veins). Fibrous
pericardium is attached in
front to sternum by
sternopericardial ligaments.

Visceral layer is called epicardium. Parietal layer lines fibrous pericardium & is reflected around roots of great vessels to become continuous with visceral layer of serous pericardium that closely covers heart.Pericardium Serous Pericardium It lines fibrous pericardium and coats heart. pericardial fluid To facilitate heart movements . Pericardial cavity is a slit-like space between parietal & visceral layers that contains a small amount of tissue fluid. It is divided into parietal & visceral layers.

Pericardium Pericardial Sinuses They are recesses in pericardium cavity formed by reflection of serous pericardium on posterior surface of heart. . Oblique sinus formed around large veins. Transverse sinus lies between reflection of serous pericardium around aorta and pulmonary trunk and reflection around large veins.

Visceral layer of the serous pericardium is innervated by branches of sympathetic trunks and vagus nerves. .Pericardium Nerve Supply of Pericardium Fibrous pericardium and parietal layer of serous pericardium are supplied by phrenic nerves.

Surfaces of the Heart: Anterior. Heart has apex and 3 surfaces Apex of heart: is formed by left ventricle. Inferior.Heart hollow muscular & pyramid shaped organ that lies freely within pericardium in mediastinum and is connected at its base to great blood vessels. It lies at level of 5th left intercostal space. 9 cm from midline where apex beat can usually palpated in living patient. is directed downward. Posterior . forward. and to the left.

Right & left ventricles are separated by anterior interventricular groove. by left ventricle and part of left auricle. which are separated from each other by vertical atrioventricular groove. left border. Right border is formed by right atrium.Heart Surfaces Sternocostal (Anterior) surface: is formed mainly by right atrium and right ventricle. .

Inferior surface of right atrium and inferior vena cava also forms part of this surface.Heart Surfaces Diaphragmatic (inferior) surface: is formed mainly by right and left ventricles separated by posterior interventricular groove. .

or (posterior surface): is formed mainly by left atrium. The base of heart lies opposite apex.Heart Surfaces Base of heart. into which open four pulmonary veins. .

and below. left border by left auricle. apex is formed by left ventricle. . Lower border mainly by right ventricle but also by right atrium.Heart Borders of the Heart Right border is formed by right atrium. by left ventricle.

. and lined internally with a layer of endothelium. epicardium.Chambers of the Heart Heart is divided by vertical septa into four chambers: right & left atria and right & left ventricles. covered externally with serous pericardium. myocardium. Walls of the heart are composed of cardiac muscle. endocardium. Right atrium lies anterior to left atrium. and right ventricle lies anterior to left ventricle.

. Part of atrium in front of this ridge is roughened or trabeculated by bundles of muscle fibers. auricle. This anterior part is derived embryologically from primitive atrium. Main part of atrium that lies posterior to this ridge is smooth walled and is derived embryologically from sinus venosus. which run from crista terminalis to auricle. musculi pectinati. which on the inside forms a ridge called crista terminalis.Chambers of the Heart Right Atrium It consists of a main cavity and a small out-pouching. There is a vertical groove on outside of the heart at junction between right atrium and right auricle called sulcus terminalis.

It returns blood to heart from lower half of the body. it has no valve. nonfunctioning valve. It returns blood to heart from upper half of body. It is guarded by a rudimentary. which drains most of blood from the heart wall. opens into right atrium between inferior vena cava and atrioventricular orifice. .Chambers of the Heart Openings into the Right Atrium: Superior vena cava opens into upper part of right atrium. nonfunctioning valve. Coronary sinus. Right Atrioventricular Orifice lies anterior to inferior vena cava opening and is guarded by tricuspid valve. it is guarded by a rudimentary. Inferior vena cava opens into lower part of right atrium.

Floor of the fossa represents persistent septum primum of heart of embryo. and anulus is formed from lower edge of septum secundum. Fossa ovalis is a shallow depression. which is site of foramen ovale in fetus. Anulus ovalis forms upper margin of fossa. .Chambers of the Heart Fetal Remnants of right atrium: Rudimentary valve of inferior vena cava Fossa ovalis & Anulus ovalis: lie on atrial septum.

Its cavity becomes funnel shaped near pulmonary orifice called (infundibulum). Walls of right ventricle are much thicker than those of right atrium and show several internal projecting ridges formed of muscle bundles trabeculae carneae.Chambers of the Heart Right Ventricle It communicates with right atrium through atrioventricular orifice and with pulmonary trunk through pulmonary orifice. One type of these trabeculae carneae are Papillary muscles: which project inward. being attached by their bases to ventricular wall. their apices are connected by fibrous chords (chordae tendineae) to cusps of tricuspid valve. .

When ventricle contracts. Chordae tendineae of one papillary muscle are connected to adjacent parts of two cusps. whereas their free edges & ventricular surfaces are attached to chordae tendineae.Chambers of the Heart Tricuspid valve guards atrioventricular orifice and consists of 3 cusps formed by a fold of endocardium with some connective tissue enclosed: Anterior. Septal & Inferior (posterior) cusps. Bases of cusps are attached to fibrous ring of heart skeleton. . papillary muscles contract and prevent cusps from being forced into atrium and turning inside out as intraventricular pressure rises.

Chambers of the Heart Pulmonary valve guards pulmonary orifice and consists of 3 semilunar cusps formed by folds of endocardium with some connective tissue enclosed. At root of pulmonary trunk are 3 dilatations (sinuses) each one is situated external to each cusp. Open mouths of cusps are directed upward into pulmonary trunk. . attachments of sides of cusps to arterial wall prevent cusps from prolapsing into ventricle. No chordae or papillary muscles are associated with these cusps.

open through posterior wall with no valves Left Atrioventricular Orifice: is guarded by mitral valve. Interior of left atrium is smooth. . Behind it lies oblique sinus of serous pericardium. and fibrous pericardium separates it from esophagus. Openings into the Left Atrium: Four pulmonary veins: two from each lung. but left auricle possesses muscular ridges. Left atrium is situated behind right atrium and forms greater part of base (posterior surface) of heart.Chambers of the Heart Left Atrium It consists of a main cavity and a left auricle.

Walls of left ventricle are three times thicker than those of right ventricle. There are well-developed trabeculae carneae. left ventricle is circular.Chambers of the Heart Left Ventricle It communicates with left atrium through atrioventricular orifice and with aorta through aortic orifice. . In cross section. Part of ventricle below aortic orifice is called aortic vestibule. right is crescentic because of bulging of ventricular septum into cavity of right ventricle. . two large papillary muscles.

Anterior aortic sinus gives origin to right coronary artery. Anterior cusp is the larger and intervenes between atrioventricular and aortic orifices. It consists of two cusps.Chambers of the Heart Mitral valve guards atrioventricular orifice. Aortic valve guards aortic orifice and is similar to pulmonary valve. which have a structure similar to that of tricuspid valve. and left posterior sinus gives origin to left coronary artery . Behind each cusp aortic wall bulges to form an aortic sinus. one anterior and one posterior.

Ventricles are thick-walled and divided by ventricular (interventricular) septum into right and left ventricles. myocardium. . Atria are thin-walled and divided by atrial (interatrial) septum into right and left atria. covered externally by epicardium and lined internally by endocardium.Structure of the Heart Walls of the heart: are composed of thick layer of cardiac muscle. with one surface facing forward and to the right and the other facing backward and to the left. Septum is placed obliquely. Lower part of septum is thick and formed of muscle and smaller upper part of septum is thin & membranous and attached to fibrous skeleton.

Skeleton of heart forms basis of electrical discontinuity between atria and ventricles.Structure of the Heart Skeleton of the heart: consists of fibrous rings that surround atrioventricular. . Fibrous rings around atrioventricular orifices separate muscular walls of atria from those of ventricles but provide attachment for muscle fibers. pulmonary. and aortic orifices and are continuous with membranous upper part of ventricular septum. Fibrous rings support bases of valve cusps and prevent valves from stretching and becoming incompetent.

Structure of the Heart Conducting System of the Heart: Sinuatrial Node: is located in wall of right atrium in upper part of sulcus terminalis just to right of opening of superior vena cava. Atrioventricular Bundle of His: It descends through fibrous skeleton of heart behind septal cusp of tricuspid valve to reach upper border of muscular part of septum. then divides into two branches. Atrioventricular Node: is strategically placed on lower part of atrial septum just above attachment of septal cusp of tricuspid valve. •Right bundle branch (RBB) •Left bundle branch (LBB) Subendocardial plexus of Purkinje fibers: . one for each ventricle.

It supplies right atrium and right ventricle and parts of left atrium and left ventricle and atrioventricular septum. and at inferior border of heart it continues posteriorly along atrioventricular groove to anastomose with left coronary artery in posterior interventricular groove. Coronary arteries and their major branches are distributed over surface of heart.Arterial Supply of Heart It is provided by right and left coronary arteries. Right coronary artery arises from anterior aortic sinus of ascending aorta & runs forward between pulmonary trunk & right auricle. which arise from ascending aorta immediately above aortic valve. It descends almost vertically in right atrioventricular groove. lying within subepicardial connective tissue. .

. in 35% of individuals it arises from left coronary artery.Branches of right coronary artery: 1. It supply inferior wall & posterior part of ventricular septum. 3. Artery of sinuatrial node supplies node and right and left atria. Right conus artery: supply pulmonary conus 2. Posterior ventricular branches: supply diaphragmatic surface of right ventricle. Posterior interventricular (descending) artery: runs in posterior interventricular groove. Atrial branches supply anterior and lateral surfaces of right atrium. Large septal branch supplies AV node. Ventricular Branches: Anterior ventricular branches: supply anterior surface of right ventricle. Marginal branch: is the largest & runs along lower margin of costal surface to reach apex. One branch supplies posterior surface of both right and left atria.

It arises from left posterior aortic sinus of ascending aorta and passes forward between pulmonary trunk and left auricle. One of these ventricular branches (left diagonal artery) may arise directly from trunk of left coronary artery. and ventricular septum. It then enters atrioventricular groove & divides into an anterior interventricular branch & circumflex branch. including greater part of left atrium. A small left conus artery supplies pulmonary conus. It supplies right & left ventricles with numerous branches that also supply anterior part of ventricular septum.Arterial Supply of Heart Left coronary artery supplies major part of heart. . left ventricle. Anterior interventricular (descending) branch: runs downward in anterior interventricular groove. In most individuals it passes around apex of heart to enter posterior interventricular groove & anastomoses with terminal branches of right coronary artery.

. Atrial branches supply left atrium. but not large to provide an adequate blood supply to cardiac muscle if one of large branches becomes blocked. although sometimes collateral circulation is enough to sustain muscle. A sudden block of one of larger branches of either coronary artery usually leads to myocardial infarction. Anterior & posterior ventricular branches supply left ventricle. Coronary Artery Anastomoses between terminal branches of right & left coronary arteries exist. Left marginal artery is a large branch supplying left margin of left ventricle down to apex.Arterial Supply of Heart Circumflex artery: same size as anterior interventricular artery. It winds around left margin of heart in atrioventricular groove.

Right dominance is present in most individuals (90%). In right dominance. and most common variations affect blood supply to diaphragmatic surface of both ventricles. In left dominance. . and distribution of posterior interventricular artery are variable. Here origin.Arterial Supply of Heart Variations in the Coronary Arteries Variations in blood supply to heart do occur. size. posterior interventricular artery is a branch of circumflex branch of left coronary artery (10%). posterior interventricular artery is a large branch of right coronary artery.

Small and middle cardiac veins are tributaries of coronary sinus. It opens into right atrium to left of inferior vena cava. which lies in posterior part of atrioventricular groove and is a continuation of great cardiac vein. .Venous Drainage of the Heart Most blood from heart wall drains into right atrium through coronary sinus. Remainder of blood is returned to right atrium by anterior cardiac vein and by small veins that open directly into heart chambers.

These nerves results in cardiac acceleration. cardiac muscle fibers & coronary arteries. and parasympathetic supply comes from vagus nerves. and dilatation of coronary arteries. Sympathetic supply arises from cervical & upper thoracic portions of sympathetic trunks. These fibers results in a reduction in rate and force of contraction of heart and a constriction of coronary arteries.Nerve Supply of Heart Heart is innervated by sympathetic and parasympathetic fibers of autonomic nervous system via cardiac plexuses situated below arch of aorta. Sympathetic fibers terminate on SA & AV nodes. . increased contraction of cardiac muscle. Parasympathetic fibers terminate on SA & AV nodes and on coronary arteries.

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