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Anatomy of the Heart

Heart anatomy

What is the fibroserous sac that holds the heart and roots of the great vessels? The pericardial sac
Where is the pericardium located (landmarks)? Posterior to the body of the sternum (2 through 6th ribs); anterior to 5th through 8th thoracic vertebrae
What are the components of the pericardium (of the sac itself)? Fibrous pericardium and the serous pericardium
What are the (2) points of attachment of the fibrous pericardium? Inferior: central tendon of the diaphragm; Anterior: sternum via the sternopericardial ligaments
Where are the phrenic nerves relative to the pericardium? The periocardiophrenic nerves are embeded in the anterior surface of the fibrous pericardium; they pass IN FRONT of the root of the lung
What is the main function(s) of the fibrous pericardium? 1) Anchor the heart; 2) lmits distension
Draw the following midsagital diagram of the pericardium showing the following structures: parietal layer of the serous pericardium, large blood vessel, heart, pericardial cavity, visceral layer of serous pericardium, and fibrous pericardium See p. 64 or slides to determine if correct
What structure(s) does the firbous pericardium beldn in with superiorly? The outer coats of the great vessels passing through it.
What is the serous pericardium? The double layer sac deep to the fibrous pericardium that also surrounds the heart (continuous)
Where are the parietal and the visceral layers of the serous pericardium? Parietal P. lines inner surface of the fibrous pericardium, reflects at the roots of the great vessels to become the visceral pericardium and becomes closely applied to the heart
What is the primary function of the serous pericardium? To lubricate the moving parts of the heart (surfaces of the pericardial cavity)
Relative to the heart, where are the sinuses located? On the posterior surface of the heart
What are the two sinuses of the heart and where are they located? The transverse sinus (between aorta/pulmonary trunk and the superior vena cava) and the oblique sinus (cul de sac around the six major veins entering the heart behind the LEFT ATRIUM)
What two spaces does the transverse sinus connect? It's a passage between the right to the left of the pericardial cavity; can "scoop" the inferior surfaces of the arch of the aorta and the pulmonary trunk
What are the (4) major surfaces of the heart? Apex, sternocostal surface, diaphraghmatic surface, and the base
Where is the apex located? Major landmark? Tip of the left ventricle; points anteriorly, inferiorly, and to the left; Found in the left 5h intercostal space approximately 8-10 cm from midline
What cardiac components comprises the sternocostal surface? Right atrium, right ventricle, small part of left ventricle
What cardiac components comprise the diaphragmatic surface? Mostly left ventricle, small part of the right ventricle
What cardiac components comprise the base of the heart? Mostly left atrium and small portion of the right atrium (most superior part of the heart)
Where are the borders of the heart marked by? Right border: SVC, R. atrium, IVC; Left border: A. of aorta, P. trunk, left auricle, left ventricle; Superior Border: Great vessels; Inferior border: right ventricles, part of left ventricle
What structure divides the two parts of the right atrium? The crista terminalis
What is the crista terminalis? Smooth muscular ridge; starts at roof of atrium in front of the opening of the superior vena cava extending down to the antioer lip of the inferior van cava
What is the cavity posterior to the crista terminalis? What major vessel(s) does it receive? Sinus venarum which receives the superior and inferior vena cava
What major chamber lies anterior to the crista terminalis? The atrium proper (contains the right auricle)
What is the sulcus terminalis? Groove on the exterior surface of the heart (over the right auricle) that marks the position of the crista terminalis; extends between the superior and inferior vena cava
Describe the texture(s) of the wall of the right atrium The sinus venarum: smooth; atrium proper (anterior--includes auricle): ridged by pectinate muscles (comb-like) which fan out from crista terminalis into the auricle
Where are the pectiate muscles? In the right atrium; they fan out from the crista terminalis into the auricle
Name the openings into the right atrium Sup. vena cava, Inf. vena cava, Coronary sinus, right atrioventricular orifice
Where does the superior vena cava open into the right atrium? In the superior posterior part of the right atrium
Where does the inferior van cava open into? The inferior posterior part of the right atrium, almost in line with the SVC; contains a non-function valve of embryonic importance
Where does the coronary sinus open into ? Opens into the right atrium between the orifice of the inferior vena cava and the right atrioventricular orifice
What is the thebesian valve It is a non-functioning valve of embryonic origin
Where is the right atrioventricular orifice Lies anterior to the orifice of the IVC, guarded by the tricuspid valve
Where is the fossa ovalis A depression in the interatrial septum just above the opening of the inferior vena cava
What does the fossa ovalis mark? What did this structure do? The location of the embryonic foramen ovale, which was a hole which allow shunting from the right to the left atria
What is the prominent upper margin of the fossa ovalis called? The limbus fossa ovalis
How does the right ventricle communicate with the right atrium? Via the right atrioventricular orifice
How does the rigth ventricle communicate with the pulmonary trunk? Via the pulmonary orifice
The right ventricle is partially divided into inflow and outlfow tracts by a smooth muscular crest called ______ Supraventricular crest
Which of the tracts is posterior? Which of the tracts is anterior? What are their walls like? Inflow: posterior (rough); outflow: anterior (smooth)
What is the infundibulum? What is its shape and function? It is the ouflow tract for the right ventricle; it is funnel shaped; it is also called the conus arterious
What are the inflow tract walls lined with? Prominent fleshy ridges called the trabeculae carnae
What structures does the trabeculae give rise to? The paillary muscles; shaped like columns/nipples
How many sets of papillary muscles are there? What are they and how are they named? Three sets: anterior, posterior, septal; named according to location of their bases
What structure attaches the apex of each papillary muscle to the cusps of the tricuspid valve? Chordae tendinae
Which of the papillary muscles is the most constant + prominent? The anterior papillary muscle; spring from the wall of the septum
What is the function of the papillary muscles and the chordae tendinae? Prevent eversion of the atrioventricular valve into the atrium during ventricular systole
Where is the tricuspic valve? Between the right atrium and the right ventricle
What are the three cusps of the tricuspid valve called? anterior, posterior, and septal cusps
How are they secured? Bases of the cusps secured to the fibrous ring of the heart
* What is the septomarginal trabeculae (Moderator band) Specialized trabeculae carnae running from the interventricular septum to the base of the anterior papillary muscle; carries right branch of the bundle of His to the anterior papillary muscle
How many valves does the pulmonary valve have? Composed of three delicate cup-shaped valves (valvules)
How are the cusps named? One is anterior, the other two are right and left and named accordingly
What is a nodule in the pulmonary valve? The center of the free margin of each cusp
What is a lanula in the pulmonary valve? The thin margins of each side of the nodule
What is the location and the role of the sinus of the pulmonary trunk? They are pockets/sinuses/dilations of the pulmonary trunk where the cusps attach along the curved inferior margins of each sinus; backflow of blood during diastole fills the sinuses, but the cusps prevent regurgitation of blood
How many internal sections does the left atrium have? Two internal sections, but no definite line of demarcation
What veins empty into the posterior portion of the heart? Four pulmonary veins empty into the posterior portion
What is the texture of the walls of the posterior part of the left atrium They are smooth
What structures line the walls of the anterior wall and the left auricle of the left atrium? Pectinate muscles (musculi pectinati)
What structure is in contact with the posterior side of the left atrium? What layers/spaces lie between them? The esophagus; only the oblique sinus and the pericardium lie between them
How does the left ventricle differ from the right ventricle (in terms of muscular wall)? The walls are ~3x thicker; trabeculae carnae not as well developed
What is the outflow tract of the left ventricle called? What similar structure exists in the right ventricle? Aortic vestibule; anologous to the conus arterious
What separates the two ventricles? The interventricular septum
What are the two main portions of the interventricular septum called? 1) pars muscularis (thick and muscular); 2) Pars membranacea (thin membranous). P. membranacea lies above the muscularis and close to the atrioventricular orifices
Where is the mitrial valve? How many cusps does it have? What attaches them (cusps) to the wall? Guards the atrioventricular orifice between the left atrium and ventricle; two cusps; anterior and posterior papillary muscles (via chordae tendinae)-->each chordae tendinae attached to BOTH cusps
What is the cardiac skeleton? How is it organized? What is its function? Fibrous connective tissue that forms the central support of the heart; has four fibrous rings for attachment of the valvules and cusps of the heart valves and bundles of the atrial and ventricular muscle fibers; prevent excessive valve stretching
What is the physiological significance of the cardiac skeleton? Atrial bundles attached to upper borders of rings; ventricular bundels attached to the lower bundles of the rings-->two sets of muscle bundles electrically separated except through specialized conducting system
Where does the right coronary artery arise from? Where does it emerge from? The right right aortic sinus-->emerges on the right side of the pulmonary trunk
Where does it run through? Runs through the right coronary sulcus between the right atrium and the right ventricle
What are its major branches? Sinuatrial nodal branch, right marginal branch (aka acute marginal*), AV nodal branch, posterior interventricular branch (posterior descending artery, PDA)
Where does the sinuatrial branch run through? Given off from the atrial branch near the origin of the RCA
What area does the right marginal branch supply? supplies the right border
Where is the AV nodal branch given off? At the crux of the heart
Where does the posterior interventricular branch run through? In the posterior interventricular sulcus
What structures does the right coronary artery supply? Right atrium, right ventricle (most of it), part of the left ventricle (diaphragmatic surface), posterior 1/3 of the IV septum, SA and AV nodes (most of the time)
Where does the left coronary artery arise from? From the left aortic sinus and emerges on the left side of the pulmonary trunk
Where does the left coronary artery branch? While it is still behin the left auricle, brachnes into the anterior interventricular branch (left anterior descending, LAD) and the circumflex branch
Where does the anterior interventricular artery run through? Descends towards the apex in the anterior interventricular sulcus
Where does the circumflex artery run through? What does it supply? Runs to the left in the left coronary sulcus between left auricle and left ventricle, continues onto the posterior of the hear; if it reaches the posterior interventricular sulcus, may give rise to the posterior interventricular artery
What is left coronary dominance? How common is it? in 10% of cases, the left coronary artery (by way of circumflex branch) may give rise to posterior interventricular artery
What are the branches of the circumflex artery? The left marginal branch (obtuse marginal) supplies left border; occasionally the SA and AV nodal branches
What structures does the left coronary sartery supply? left atrium, left ventricle (most), part of the right ventricle, anterior 2/3 of IV septum (including the bundle of His), SA and AV node (occasionally)
Where is the coronary sinus? What is its major role? Lies in the left coronary sulcus from the left margin of the heart to its orifice in the right atrium; receives most of the veins in the heart
Where is the great cardiac vein? Where does it pass through? What is it continuous with? Lies in the anterior interventricular sulcus and passes upward and to the left of the left coronary sulcus; becomes continous with the left margin of the hear after receiving the oblique vein of the left atrium
Where is the middle cardiac vein? Where does it pass through? Where does it empty into? Runs in the posterior interventricular sulcus; empties into the coronary sinus ont he posterior surface of the heart
Where is the small cardiac vein? Where does it pass through? Where does it empty into? Parallels the right marginal artery; passes the right coronary sulcus to the posterior of the heart and drains into the coronary coronary sinus
What are the only veins that do not empty into the coronary sinus? The anterior cardiac veins and the least cardiac veins
Where are the anterior cardiac veins? Where do they run through? Where do they empty? Arie on the anterior surface of the right ventricle, pass across the right coronary sulcus and penetrate the anterior wall of the right atrium directly
What are the venae cordis minimis (least cardiac veins)? Minute veins int he muscular walls of the heart-->empty directly into the cardiac chambers
What structure provides the sympathetic and the parasympathetic input to the heart? Where is it located? The cardiac plexus; diffuse netwrok of delicate fibers extending from in front of the trachea to the aortic arch, pulmonary trunk, and ligamentum arteriosum
What are the three cervical cardiac nerves? Where do they arise from? What signals do they carry? Superior cervical, middle cervical, and inferior cervical (named after the ganglion they arise from); sympathetic;
Where do the thoracic cardiac nerves arise from? From the upper four or five thoracic ganglia of the sympathetic trunk
The sympathetic fibers of the plexus are all ____gaglionic. Postganglionic
* Where do the preganglionic fibers of the sympathetic cardiac nerves arise from? From the upper four or five thoracic segments of the spinal cord
* What are the three main function of the sympathetic cardiac branches? Accelerate heart rate, increase force of heart beat, dilate the coronary arteries
* Where does the heart get its parasympathetic branches? From the vagus nerves
How many cervical cardiac nerves supply the heart? Where do they arise from? Two of them from the vagus nerves of the neck (superior cervical and inferior cervical)
Describe the thoracic cardiac branches arise from the vagal trunks or the recurrent laryngeal branches of the vagus
The parasympathetic fibers of the plexus from the vagi are ____ganglionic and synapse within _______ ganglia within the _______ or in the _______ of the heart preganglionic, small, plexus, walls
* What are the (3) main functions of the parasympathetic innervation of the heart? Decrease the heart rate, reduce force of contraction, constrict coronary arteries
Describe the path the afferent (sensory) fibers of the heart take to reach the spinal cord Visceral afferents from the heart join the cardiac plexus and pass along the sympathetic and the vagal cardiac branches
What information is carried by the vagal afferents of the heart? Concerned with cardiac reflexes (blood pressure, rate, etc)
* What information is carried by the sympathetic afferents of the heart? What levels of the spinal cord do they enter? Why is this significant? Conduction of the pain sensations of the heart; T1 and T5 (they enter via the dorsal roots), may result in referred pain to the dermatomes supplies by the upper thoracic spinal nerves (T1, T2: ulnar border of upper limb; T2-T5: upper part of thorax)
What are the components of the conducting system of the heart? Sinuatrial node, atrioventricular node, atrioventricular bundle (of His)
Describe the shape, location, and purpose of the sinuatrial node Crescent shaped structure (5-8 mm in length) occupying the whole thickness of the wall of the right atrium; on the anterior lip of the superior vena caval orifice near the top of the crista terminalis; pacemaker
Describe the shape, location, and purpose of the atrioventricular node Embedded in the interatrial septum close to the opening of the coronary sinus; on the fibrous AV ring close to the attachment of the septal cusp of the tricuspid valve; in the septum extends forward from the opening of the c. sinus; continues as AV bundle
Created by: karkis77