M1 Anatomy Pericardium&Heart Dupree · 7 Cut edge of fused fibrous (outside) + parietal (inside) layers of pericardium Note the opened Pericardial Sac The visceral layer of pericardium

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PERICARDIUMand

HEART

Gross Anatomyof the

M1 Gross and Developmental Anatomy8:00 AM, November 7, 2007Dr. Milton M. Sholley

Professor of Anatomy and Neurobiology 2

Jeff Dupree

Sanger Hall 9-057828-9536E-mail: [email protected]

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Right auricle

Left atrium

Right auricle

Right ventricle

Right ventricle

Left ventricle

Opened Chambersof the

Human Heart 4

Mediastinum

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Subdivisions of the Mediastinum(Mid-sagittal plane drawing from Textbook of Anatomy by W. Henry Hollinshead) 6

II. Pericardial sac

Fibrous pericardium(inferiorly fuses to centralregion of diaphragm)

Phrenic nerve:from cervical spinalnerves (C3-C5)

Pericardiacophrenic arteryand vein

7Cut edge of fused

fibrous (outside) + parietal (inside)layers of pericardium

Note the opened Pericardial Sac

The visceral layerof pericardium (orepicardium) tightlyadheres to the surfaceof the heart

The pericardial sac is the spacebetween the parietal and viscerallayers of the serous pericardium. The sac normally contains onlya thin layer of serous fluid, butinflammation of the sac(pericarditis) can causea large increase in thevolume of fluid.

Grant’s Atlas,12th Ed.,Fig. 1.21, p. 25

The parietal layerof pericardium tightly adheres tothe inside of thefibrous pericardium

The fibrous layerof pericardiumis thick and makesthe pericardialsac tough andinflexible

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Grant’s Atlas,11th Ed.,Fig. 1.57B, p. 63

Fibrous pericardium

Serous pericardiumVisceral layer

Pericardial sac

Parietal layer

Pericardial sac

Diagrammatic Coronal Section

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Grant’s Atlas,12th Ed.,Fig. 1.70A, p. 73

Superior View of Diaphragm

L R

Pericardial sac

Inferior vena cava

Aorta

Esophagus

The fibrous pericardiumis fused to the superiorsurface of the diaphragm.Thus, the heart movesup and down with thediaphragm duringrespiration.

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Fibrous pericardium:(inferiorly fuses to centralregion of diaphragm)

Epicardium:Visceral pericardiumFat and blood vessels

Myocardium:heart muscle

Endocardium:innermost endothelial layer)

Layers of the Heart Wall (page 266)

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Transverse pericardial sinus

Oblique pericardial sinus

II. Pericardial Sinuses (page 266)

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Transverse pericardial sinus:

Between pericardial attachments to pulmonary veins and SVC and the aorta and pulmonary trunk

Transverse Pericardial Sinus

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Grant’s Atlas,12th Ed.,Fig. 1.44B, p. 51

Transverse pericardial sinus

Pulmonary trunk

Left superior pulmonary vein

Left inferior pulmonary vein

The base of the heart sitshere, forming the opposite(anterior) wall of the obliquepericardial sinus. Theline of junction between theparietal and visceral layersof serous pericardiumsurrounds the six greatveins and creates a cul-de-sac known as the obliquepericardial sinus.

Right superior pulmonary vein

Right inferior pulmonary vein

Inferior vena cava

Superior vena cava

Oblique and Transverse Pericardial Sinuses

Posterior wall of opened pericardial sac – heart removed 14

The Esophagus and Thoracic Aorta liebehind the

Oblique Pericardial Sinus

Esophagus Aorta

Grant’s Atlas,12th Ed.,Fig. 1.44B, p. 51

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The Esophagus and Thoracic Aorta liebehind the

Oblique Pericardial Sinus

Esophagus Aorta

Grant’s Atlas,12th Ed.,Fig. 1.44B, p. 51

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AA

BT

RC

LC

LS

AR

DA

RS

AA = Ascending aortaAR = Aortic archDA = Descending aortaBT = Brachiocephalic trunkRS = Right subclavian a.RC = Right common carotid a.LC = Left common carotid a.LS = Left subclavian a.

19Anterior view Posterior view

Coronary (oratrioventricular)sulcus

Anteriorinterventricularsulcus

Posteriorinterventricularsulcus

Sternocostal surface Diaphragmaticsurface

Base

III. External form of the Heart

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Sulci of the Heart

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IV. Blood Supply of the Heart

Right coronary a. Left coronary a.SA nodal branch Anterior interventricularConus Diagonal branchesRight marginal CircumflexAV nodal branch Posterior ventricularPosterior interventricular Left marginal

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Coronary Arteries

Anterior view

Left coronary artery(main stem)

Right coronary artery

SA nodal branch

Grant’s Atlas,12th Ed.,Fig. 1.45A, p. 52

Right marginal branch

Circumflex branch

Left anterior descendingbranch (LAD)

Left marginal branch

Diagonal branch of LAD

Note: LAD is also calledthe anterior Interventricularbranch

Conus branch

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Coronary Arteries

Posterior view

Grant’s Atlas,12th Ed.,Fig. 1.45B, p. 52

Circumflex branch

Posterior interventricular(posterior descending) branch

Crux of heart

AV nodal branch

Note: The crux of the heart is the areaof junction of the atrioventricular andposterior interventricular sulci. If theright coronary artery gives off theposterior Interventricular (as here) thepattern is “right dominant”. If the circumflexbranch of the left coronary reaches thecrux and gives off the posterior interventricular the pattern is”left dominant”.About 60% of hearts are “right dominant”.

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Sinuatrial nodal a.

Right Coronary a.

Right marginlal a.

Left coronary a.

Circumflex a.

Anterior Interventricular a.

Marginal a.

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Sinuatrial nodal a.

Right Coronary a.

Right marginal a.

Posterior interventricular a.

Posterior ventricular a.

Left marginal a.

Circumflex a.

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Right dominant coronary circulation(what we studied just studied)

~60% of cases

Left dominant coronary circulation~40% of cases

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Single coronary artery(bad news if it becomes blocked)

Circumflex arteryarising from right coronary sinus

Anomalous Origins of Coronary Arteries

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LIMA Graft Provides an Artery to ArteryBypass around a Blocked LAD

LAD

LIMA

The left internal mammary artery (LIMA) lies very close (just outsidethe pericardial sac) to the left anterior descending artery (LAD). It canbe diverted and anastomosed to the LAD to bypass a blockage inthis important arterial supply to the left ventricle and interventrticularseptum.

Fibrouspericardium

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Cardiac veins

Great cardiacMiddle cardiacSmall cardiac

Anterior cardiacLeast cardiac

30Anterior viewGrant’s Atlas,12th Ed.,Fig. 1.46A, p. 53

Cardiac veins

Great cardiac vein

Middle cardiac vein

Oblique vein ofleft atrium

Anterior cardiac veins

Small cardiac vein

Coronary sinus

31Posterior view

Grant’s Atlas,12th Ed.,Fig. 1.46D, p. 53

Cardiac veins

Great cardiac vein

Middle cardiac vein

Oblique vein ofleft atrium

Small cardiac vein

Coronary sinusLeft marginal vein

Left posteriorventricular vein

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Right auricle

Left atrium

Right auricle

Right ventricle

Right ventricle

Left ventricle

Opened Chambersof the

Human Heart

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Right Atrium Opened

Grant’s Atlas,12th Ed.,Figs. 1.49 A&B, p. 56

Cristaterminalis

Right atrioventricularorifice

Pectinate muscles(rough partof wall)

Valve of IVCIVC

SVC

Fossa ovalis

Orifice ofcoronary sinus

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Grant’s Atlas,12th Ed.,Figs. 1.50 A, p. 57

Right Ventricle Opened

Moderator band

Anterior papillary muscle

Septal cusp

Posterior cusp

Posterior papillarymuscle

Anterior cusp

Septal papillary musclesConusarteriosus

Chordaetendineae

Orifice of pulmonary valve

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Left auricle

Left superior pulmonary v.

Valve of foramen ovale

Right pulmonary v.

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Left Ventricle Opened

Grant’s Atlas,12th Ed.,Figs. 1.52A, p. 59

Anterior cusp ofmitral valve

Posterior cusp ofmitral valve

Anterior papillarymuscle

Posterior papillarymuscle

Chordaetendineae

Trabeculaecarneae

Left aortic sinus

Left cusp ofaortic valve

Right aortic sinusRight cusp ofaortic valve

Orifice of rightcoronary artery Orifice of left

coronary artery

Posterior (non-coronary)cusp of aortic valve

Posterior sinus ofaortic valve

Membranousinterventricular septum

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RC PC LC

Left coronary arteryRight coronary artery

Lunule Nodule

Aortic sinus

Nodules meet whenthe valve cusps

close

Orifice of acoronary

artery

Detail of the Aortic Semilunar Valve

Orifice of the rightcoronary artery

Orifice of the leftcoronary artery

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Grant’s Atlas,12th Ed.,Figs. 1.53 & 1.54C, p. 60

Aortic and Pulmonary Semilunar Valves

P L

R R

LA

Aortic valve

Pulmonary valve

Superior view 40

Cardiac Conduction System

SA node

AV node

Orifice ofcoronarysinus

AV bundle

Rightbundle branch

Leftbundle branch

Orifice ofcoronarysinus

Crista terminalis

Location of SA node

Location of AV node

Superior vena cava

Interventricular septum

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This diagram shows the cardiac nerves and the locations of the superficial (a) and deep (b) cardiac plexuses. Vagal branches are shown as dashed lines and sympathetic branches are shown as dotted lines. The thoracic cardiac nerves from the upper thoracic sympathetic trunks are not shown. (From Textbook of Anatomy by W. Henry Hollinshead)

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Auscultation Sites for the 4 Heart Valves

Actual locations of the 4 heart valvesprojected onto the anterior thoracic wall. The actual locations do not correspond to the sites of auscultation. The sites of auscultation are where the chamber distal (in terms of blood flow) to the valve lies closest to the body surface. P=Pulmonary valve, A=Aortic valve, M=Mitral valve, and T=Tricuspid valve. (From Textbook of Anatomy by W. Henry Hollinshead)