Pericardium & Heart

Thorax Unit
Lecture 5 & 6
.

Pericardium
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

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.

Pericardium

Serous Pericardium
It lines fibrous pericardium and coats heart. It is
divided into parietal & visceral layers. 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.
Visceral layer is called
epicardium.
Pericardial cavity
is a slit-like space between
parietal & visceral layers that
contains a small amount of
tissue fluid, pericardial fluid
To facilitate heart movements

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.

Pericardium

Nerve Supply of Pericardium

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

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

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

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

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

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

Chambers of the Heart

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

Chambers of the Heart

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

Chambers of the Heart

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

Chambers of the Heart

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

Chambers of the Heart

Right Ventricle
It communicates with right atrium through atrioventricular
orifice and with pulmonary trunk through pulmonary
orifice. 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. 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.

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, whereas their
free edges & ventricular
surfaces are attached to
chordae tendineae. When
ventricle contracts,
papillary muscles contract
and prevent cusps from
being forced into
atrium and turning inside
out as intraventricular
pressure rises. Chordae
tendineae of one papillary
muscle are connected to
adjacent parts of two cusps.

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. Open mouths of cusps
are directed upward into pulmonary trunk. No chordae
or papillary muscles are associated with these cusps;
attachments of sides of cusps to arterial
wall prevent cusps from prolapsing into
ventricle. At root of pulmonary
trunk are 3 dilatations (sinuses)
each one is situated external
to each cusp.

Chambers of the Heart

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

Chambers of the Heart

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

Chambers of the Heart

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

Structure of the Heart

Walls of the heart: are composed of thick layer

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

Structure of the Heart

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

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 Node: is strategically placed on lower
part of atrial septum just above attachment of septal cusp
of tricuspid valve.
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, one for each ventricle.
Right bundle branch (RBB)
Left bundle branch (LBB)
Subendocardial plexus
of Purkinje fibers:

Arterial Supply of Heart

It is provided by right and left coronary arteries,

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

Branches of right
coronary artery:

1. Right conus artery: supply pulmonary conus

2. Atrial branches supply anterior and lateral surfaces of
right atrium. One branch supplies posterior surface of both
right and left atria. Artery of sinuatrial node supplies
node and right and left atria; in 35% of individuals it arises
from left coronary artery.
3. 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.
Posterior ventricular branches:
supply diaphragmatic surface
of right ventricle.
Posterior interventricular
(descending) artery: runs in
posterior interventricular
groove. It supply inferior wall &
posterior part of ventricular septum.
Large septal branch supplies
AV node.

Arterial Supply of Heart

Left coronary artery supplies major part of heart,
including greater part of left atrium, left ventricle, and
ventricular septum. It arises from left posterior aortic sinus
of ascending aorta and passes forward between pulmonary
trunk and left auricle. It then enters atrioventricular groove
& divides into an anterior interventricular branch &
circumflex branch.
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. It supplies right & left
ventricles with numerous branches
that also supply anterior part of
ventricular septum. One of these
ventricular branches (left diagonal
artery) may arise directly from trunk
of left coronary artery. A small left
conus artery supplies pulmonary conus.

Arterial Supply of Heart

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

Arterial Supply of Heart

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

Venous Drainage of the

Heart

Most blood from heart wall drains into right atrium

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

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
supply arises from cervical & upper thoracic portions of
sympathetic trunks, and parasympathetic supply comes
from vagus nerves.
Sympathetic fibers terminate on SA & AV nodes,
cardiac muscle fibers & coronary arteries. These nerves
results in
cardiac acceleration, increased contraction
of cardiac muscle, and dilatation of
coronary arteries.
Parasympathetic fibers terminate on
SA & AV nodes and on coronary
arteries. These fibers results
in a reduction in rate and force of
contraction of heart and a
constriction of coronary arteries.

Thank You