Prof.

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THE HEART

• By
• Prof.
• Saeed Abuel Makarem

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• Pericardium
• A fibro-serous sac
• Surrounds the heart proximal part of its great
  vessels (Aorta, Pulmonary trunk, SVC, IVC, 4
  pulmonary veins)
• Formed of
• Outer fibrous layer
• Inner serous sac
• Serous sac has 2 layers
• Parietal Visceral (epicardium)

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• Fibrous Pericardium
• Conical or flask shape
• Apex directed upwards fused with adventitia of 3
  big vessels
• Base rests on diaphragm
• Fuses with central tendon of diaphragm.
• Posteriorly Separated by post. Mediasinum from
  middle four thoracic vertebrae (5 to 8)
• Anteriorly body of sternum, costal cartilages
  ant. Border of lung pleura, remains of thymus
  2 Sterno-pericardial ligaments
• Extends from 2nd to 6th rib

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• Function of serous pericardium
• 1- Lubrication to prevent friction
• 2- Prevent adhesion of the heart to its
  surrounding

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• Function of fibrous pericardium
• 1-Maintain the central position of the heart
• 2-Keeps large vessels open
• 3-Helps venous return
• 4-Acts as a wall for serous
• pericardium.
• 5- Prevents overdistention of the heart
• Serous pericardium
• Serous sac that has been invaginated by
  developing heart in fetal life
• Visceral layer Epicardium.
• Parietal layer Lines fibrous pericardium
• Pericardial cavity potential space.

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• Sinuses of pericardium
• 2 sinuses in serous pericardium
• (Transverse Oblique)
• Transverse sinus
• A recess behind pulmonary trunk ascending
  aorta
• Boundaries
• Ant Pulmonary trunk ascending
  aorta.
• Post SVC Upper part of the 2 atria
  
• Above Rt. Pulmonary artery
• Below the 2 atria mainly Lt.

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• Oblique sinus
• It separates the base of heart (left atrium) from
  posterior mediastinum (descending aorta
  esophagus)
• Boundaries
• Ant back of Lt. atrium
• Post fibrous pericardium posterior mediastinum
• Left 2 Left pulmonary veins
• Right 2 right pulmonary veins IVC

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• Heart
• Muscular pump that keeps circulation going on.
• It is the size of hands fist of the same person
• 2/3 of its breadth lies to left of median plane
  and 1/3 right to median plane
• It is conical in shape having an apex, base,
• Sterno-costal, diaphragmatic, surfaces
• and right, and left borders.

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• Apex
• Directed downwards, forwards to left
• Lies in LT. 5th Intercostal space 3 ½ inches (
  9 cm) from median plane.
• Formed only by LT. ventricle.
• Pericardium diaphragm separate the apex from
  fundus of stomach

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• Base
• Directed backwards and slightly to right.
• Formed by 2 atria mainly the left atrium.
• Separated from post Mediastinum by oblique sinus
  of pericardium
• Lies opposite middle 4 thoracic vertebrae (5 to
  8)
• Bounded inferiorly by coronary groove that lodge
  the coronary sinus.

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• Sterno-costal surface
• Lies behind body of sternum 3 to 6 costal
  cartilages.
• Divided by coronary groove into
• Atrial part Rt. Atrium
• Ventricular part the two ventricles, mainly Rt.
• Borders
• Upper Straight, formed by the 2 atrium but
  concealed by the ascending aorta pulmonary
  trunk.
• Lower Concave formed by Rt. Ventricle apical
  part of Lt ventricle
• Rt. Convex formed by Rt. Atrium
• Lt. Convex ,formed by Lt. auricle and Lt.
  ventricle.

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• Surface anatomy of Heart
• Point1 Lower border of 2nd Lt costal cartilage
  one half inches from the median plane.
• Point 2 Upper border of Rt. 3rd costal
  cartilage one inch from medial plane.
• Point 3 Upper border of Rt. 6th costal cartilage
  one inch from its junction with the sternum.
• Point 4 Apex Lt. 5th Intercostal space 3 ½
  inches from median plane.

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• Surface anatomy of the valves
• Pulmonary Left 3rd sternocostal junction
• Aortic Left 3rd Intercostal space just left to
  sternum
• Mitral Left 4th sternocostal junction
• Tricuspid 4th Intercostal space near the middle
  line.

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Auscultation of the cardiac valves
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• Diaphragmatic surface
• Left 2/3 of this surface are formed by Lt
  ventricle
• Rt. 1/3 is formed by Rt. Ventricle
• The 2 ventricles are separated by post.
  Interventricular groove.
• The groove lodges the post. Interventricular
  artery middle cardiac vein

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Both coronary arteries lie in the
atrioventricular groove (coronary Sulcus). While
their branches lie in the interventricular
grooves.

• Right Coronary Artery
• It arises from ant. aortic sinus, at the root of
  ascending aorta
• It passes forwards between Rt. auricle
  pulmonary trunk.
• Then it passes downwards and to the right in
  coronary groove to reach the lower margin of the
  heart
• Then it curves backward to runs in the
  posterior part of the coronary sulcus.
• Termination By anastomosis with the circumflex
  branch of left coronary.

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• Branches of right coronary artery
• 1- Marginal Small branch passes along the lower
  border, from right to left.
• 2- Posterior interventricular artery
  (descending) Medium sized, passes near its
  termination into the posterior interventricular
  groove to end in a poor anastomosis with the
  termination of the anterior interventricular
  artery, from the left coronary artery.
• 3- Small twigs to the ascending aorta and
  pulmonary trunk.
• 4- A branch to the S.A. node, which also supplies
  right atrium.
• 5- A branch to AV node.
• 6- Small branches to right atrium right
  ventricle.
• So the right coronary supplies the right side of
  the heart and posterior part of the
  interventricular septum.

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Left coronary arteryOrigin
From Left posterior Aortic sinus, (larger than
the Rt. Coronary).

• Lies between left auricle and root of pulmonary
  trunk, till the anterior interventricular groove,
  where it divided into
• 1- Circumflex artery.
• 2- Anterior interventricular a.
• Branches
• 1- Anterior interventricular.
• 2- Circumflex artery.
• 3- Diagonal artery.
• 4- Left marginal branch.

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Venous Drainage Of The Heart

• Most of venous blood drains to Rt. Atrium,
  through coronary sinus which is the continuation
  of great cardiac vein.
• It opens into Rt. Atrium to the left of IVC.
• Small Middle Cardiac veins are tributaries of
  coronary sinus.
• Some blood drained into anterior cardiac vein to
  the Rt. Atrium.
• Venae cordis minimi drain to all chambers of
  heart.

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