heart. pericardium 1. visceral = inseparatable with epicardium 2. parietal = outer layer of sac 3....
TRANSCRIPT
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Heart
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Pericardium
• 1. visceral = inseparatable with epicardium2. parietal = outer layer of sac3. pericardial cavity
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Major vessels
• all covered by visceral pericardium• pulmonary trunk - exits right ventricle from
anterior surface• aorta - exits left ventricle just posterior to
pulmonary trunk• superior vena cava - enters right atrium on right,
posterior to aorta• inferior vena cava - enters right atrium, inferior to
superior vana cava• pulmonary veins - (4) upper & lower on right &
left - enter left atrium, posterior side of heart
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Surface Structure of Chambers
• Right Ventricle - forms majority of anterior (sternocostal) surface
• Right Atrium - forms right lateral surface– auricle - pointed tissue appendage on surface
of both atria– atrioventricular (coronary) sulcus - groove
separates atrium & ventricle - holds coronary artery, sinus
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Surface Structure of Chambers
• Left Ventricle - forms left side of anterior surface, most of posterior– a. anterior, posterior interventricular sulcus -
separate right, left ventricles - hold coronary artery and vein
– b. apex - pointed inferior end of heart,
• Left Atrium - most superior– base of heart
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Inner structure of Chambers
• Wall layers - all chambers– endocardium - inner layer lining chambers -
continuous with vessel endotheliu– myocardium - bulk of muscle walls– epicardium – inseparable with visceral
pericardium
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Right atrium
• crista terminalis - ridge of muscle connects superior and inferior vana cava (= sulcus terminalis on surface)
• Pectinate muscle - small muscle ridges inside anterior wall of right atrium
• sinus venarum - smooth surfaced area where veins enter right atrium entrances of superior and inferior vana cava, coronary sinus
• Right atriventricular orifice, tricuspid valve• interatrial septum, fossa ovalis - remnant of
foramen ovale (in fetus) *check if patent
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1. Sinus venarum 2. Terminal crest 3. Fossa ovalis 4. Rim or limbus of the fossa ovalis 5. Musculi pectinati 6. Valve of the inferior vena cava
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Right ventricle • anterior wall = sternocostal surface• medial wall = Interventricular septum• inferior wall = diaphragmatic surface• conus arteriosus /infundibulum - superior part of right
ventricle, narrows toward pulmonary trunk • opening to pulmonary trunk, pulmonary valve - behind 3d
left costal cartilage• Right atrioventricular orifice, tricuspid valve - attached at
peripheral edge to anulus fibrosus (ring)• trabeculae carneae - ridges of muscle on inner surface -
except in conus arteriosus• chordae tendineae - fibrous tissue, attach ends of valve
cusps to papillary muscles
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Left atrium
• 4 openings of pulmonary veins
• Left atrioventricular orifice, mitral (bicuspid) valve
• Pectinate muscle, interatrial septum, fossa ovalis
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Left ventricle
• aortic valve: three cusp, 3rd intercostal space• ascending aorta - (becomes aortic arch behind
sternal angle)– R, L coronary arteries - exit ascending aorta just distal
to valve cusps• Left atrioventricular orifice, bicuspid valve,
anulus fibrosus, chordae tendineae, papillary muscles
• Trabeculae carneae - except in aortic vestibule ( smooth region, fibrous and leads to ascending aorta)
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Coronary vessels
• Right coronary artery - in coronary sulcus; travels to the right & inferiorly– supplies right atrium, right ventricle, posterior part of
interventricular septum, SA and AV node, AV bundle; also part of left atrium and left ventricle
– Right marginal artery – runs towards the apex of the heart
– posterior interventricular artery - sits in posterior interventricular sulcus, supplies both ventricles (anastomoses with anterior interventricular artery)
– most likely (85%) an atrioventricular (AV) nodal artery
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Coronary vessels
• Left coronary artery - curves left in coronary sulcus, divides quickly– supplies left atrium, left ventricle, anterior IV septum,
part of right atrium– anterior interventricular artery - in anterior
interventricular sulcus, to the apex of the heart, supplies both ventricles and interventricular septum
– circumflex artery. - continues left in coronary sulcus around to posterior of heart, supplies left atrium, base of left ventricle
– Left marginal artery, branch of circumflex
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Coronary vessels
• The branches of coronary artery are end branches. They supply regions of cardiac muscle without overlap of other large branches. Anastomoses are generally not large enough for survival.
• Large branch occluded distal region ischemic necrosis MI
• Risk factor: Coronary atherosclerosis
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Coronary vessels
• Angina pectoris:
• Exertion, stress, exercise after meal
• Most common sites for coronary occlusion:– The anterior interventricular branch of the left
coronary artery– The right coronary artery– The circumflex artery of left coronary artery
• Treatment: Bypass operation
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Veins
• Great cardiac vein - in anterior interventricular sulcus - around left side in coronary sulcus, empties into coronary sinus (along with anterior interventricular artery)
• Middle cardiac vein - in posterior interventricular sulcus - also empties into coronary sinus (along with posterior interventricular artery)
• Small cardiac vein - around right side in coronary (with marginal branch of the right coronary artery)
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Veins
• coronary sinus - largest coronary vein; in posterior coronary groove, drains into right atrium