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Which border of the heart is sharply formed by the right ventricle and a small portion of the left ventricle?
What primarily composes the anterior surface of the heart?
Which sulcus encircles the heart separating the atria from the ventricles?
Which layer of the heart is known as the visceral layer of the serous pericardium?
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During which part of the heart's function does the right side receive deoxygenated blood?
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What is responsible for separating the two ventricles of the heart?
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What primarily faces the left lung and comprises mainly the left ventricle?
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What primarily fills the pericardial cavity to facilitate heart movement?
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What is the purpose of the valves that separate each atrium and ventricle in the heart?
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Which artery is considered the primary arterial supply to the serous pericardium?
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The transverse pericardial sinus is located in relation to which vessels?
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Which nerve is primarily responsible for the sensory innervation of the pericardium?
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What condition is characterized by inflammation of the pericardium and can cause chest pain?
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Which of the following is NOT a contributor to venous drainage from the pericardium?
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What anatomical feature is described as the potential space between the parietal and visceral layers of the serous pericardium?
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During cardiac surgery, what procedure involves placing a clamp around the aorta or pulmonary trunk?
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What structure separates the inflow portion of the right ventricle from the outflow tract?
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Which statement accurately describes the composition of the pulmonic valve?
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What is the primary function of the papillary muscles in the right ventricle?
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What is the role of the conus arteriosus in the right ventricle?
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Which of the following describes the structure of the tricuspid valve?
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During which phase of the cardiac cycle do the papillary muscles contract?
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How many papillary muscles are associated with the right ventricle?
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What occurs to the cusps of the tricuspid valve during the filling of the right ventricle?
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What structure primarily drains the heart's venous blood?
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Which structure is primarily impacted by infundibular pulmonary stenosis?
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Where is the SA node located?
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What is the first phase of the cardiac cycle characterized by?
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What is the role of the bicuspid valve during ventricular contraction?
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What follows atrial contraction during the cardiac cycle?
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What is the embryological origin of the left atrium?
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Which portion of the left atrium contains the interatrial septum?
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Which part of the heart's conducting system is responsible for initiating the heartbeat?
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What is a potential clinical consequence of thrombi in the left atrium?
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What is a common function of the smallest cardiac veins?
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Which lymphatic structure does the myocardium primarily drain into?
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Which phase of the cardiac cycle occurs immediately after the closure of the atrioventricular valves?
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Match the anatomical structures with their corresponding functions:
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Match the cardiac conditions with their related anatomical structures:
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Match the pericardial features with their descriptions:
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Match the parts of the heart with their blood flow functions:
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Match the cardiac vasculature components with their respective roles:
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Which anatomical structure is primarily responsible for preventing the heart from overfilling?
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What is the main function of the phrenic nerves within the middle mediastinum?
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Which vessel is NOT considered part of the roots of the great vessels located in the middle mediastinum?
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In which anatomical area does the pericardium primarily lie?
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What is a potential consequence of gravity on the structures within the middle mediastinum during physical examinations?
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Which feature of the pericardium is primarily responsible for its protective qualities?
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How does the structure of the fibrous pericardium primarily contribute to heart physiology?
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What anatomical boundary demarcates the location of the middle mediastinum?
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What is the primary function of the serous fluid in the pericardial cavity?
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In which anatomical location is the oblique pericardial sinus found?
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Which artery is primarily responsible for the arterial supply to the serous pericardium?
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What type of nerve fibers are primarily responsible for providing sensory innervation to the pericardium?
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What distinguishes pericarditis from myocardial infarction?
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What clinical procedure allows blood circulation to be diverted during cardiac surgery?
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Which layer of the serous pericardium covers the external surface of the heart?
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Which structure lies anterior to the superior vena cava in relation to the transverse pericardial sinus?
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What condition is primarily indicated by fused valve cusps leading to a narrowing effect?
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Which anatomical feature is not present in the left atrium's anterior half?
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What physiological structure prevents blood backflow from the left ventricle during contraction?
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In the context of thrombi formation in the heart, what is the correct transformation of a detached thrombus?
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What embryological structures contribute to the formation of the left atrium?
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What structural feature of the right atrium distinguishes it from the left atrium?
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Why does the left ventricle have thicker walls than the right ventricle?
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Which area of the right atrium contains smooth, thin-walled tissue where blood enters from the major veins?
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What is a potential effect of larger atrial septal defects (ASDs)?
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Where does blood enter the right ventricle from the right atrium?
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What role does the interatrial septum play in fetal circulation?
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What is the anatomical consequence of a patent foramen ovale that is probe-sized?
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Which anatomical feature assists in increasing the capacity of the right atrium?
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Which feature is characteristic of the fibrous pericardium?
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Which valve separates the left atrium from the left ventricle?
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Which vessel primarily supplies blood to the muscular layer of the heart during its function?
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What is the primary role of the cardiac skeleton?
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Which condition results from excess fluid accumulation in the pericardial cavity?
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During which phase of the cardiac cycle do the ventricles fill with blood?
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What is the consequence of obstruction in the right coronary artery?
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Which area of the heart is primarily responsible for initiating the heart's electrical impulses?
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Study Notes
Internal Sac and Serous Pericardium
- Composed of a single epithelial layer with parietal and visceral layers.
- Parietal layer lines the fibrous pericardium, while the visceral layer (epicardium) covers the heart's outer surface.
- The pericardial cavity, located between the two layers, contains serous fluid that facilitates heart movement.
Pericardial Sinuses
- Transverse pericardial sinus: Located posterior to ascending aorta/pulmonary trunk and anterior to SVC; serves as a passage between reflected layers.
- Oblique pericardial sinus: Found behind the left atrium, surrounding the pulmonary veins.
Vascular Supply
- Main arterial supply from pericardiacophrenic artery.
- Additional contributions from internal thoracic, musculophrenic, bronchial, esophageal, and superior phrenic arteries.
- Coronary arteries supply the visceral layer of serous pericardium.
Venous Drainage
- Pericardiacophrenic veins drain into the azygos system, including internal thoracic and superior phrenic veins.
Neural Innervation
- Phrenic nerve (C3-C5): Primary sensory nerve; referred pain to the supraclavicular region and lateral neck.
- Vagus nerve (CN X): Function remains uncertain.
- Sympathetic trunks provide vasomotor innervation.
Clinical Considerations
- Surgical techniques involve clamping around the aorta/pulmonary trunk for interventions like coronary artery bypass grafting.
- Pericarditis causes chest pain and a pericardial friction rub; distinguishable from myocardial infarction due to differing prognosis and treatment.
Heart Borders and Surfaces
- Right border: Formed mainly by the right atrium; between SVC/IVC.
- Inferior border: Sharp edge from right ventricle, including some left ventricle.
- Left border: Obtuse margin formed by the left ventricle and its auricle.
- Anterior surface: Sternocostal surface primarily made up of the right ventricle.
- Posterior surface: Faces the left lung; mainly the left ventricle.
External Sulci and Heart Layers
- Coronary sulcus separates atria from ventricles; encircles major coronary arteries and veins.
- Anterior/posterior interventricular sulci separate the ventricles; associated with great and middle cardiac veins.
- Heart is composed of three layers:
- Epicardium (visceral pericardium)
- Myocardium (cardiac muscle)
- Endocardium (endothelium and connective tissue)
Internal Anatomy of the Heart
- Heart functions as two pumps (right for deoxygenated blood to the lungs, left for oxygenated blood to the body).
- The right ventricle has trabeculae carneae and papillary muscles attached to chordae tendineae for valve function.
- Septomarginal trabecula serves as a shortcut for the right bundle branch.
- The pulmonary valve, located at the conus arteriosus, prevents backflow post-ventricular contraction.
Left Atrium and Ventricle
- Left atrium receives blood from pulmonary veins, has a muscular auricle.
- Blood passes to the left ventricle through the left atrioventricular orifice, closed by the bicuspid valve during contraction.
- Left ventricle has the thickest myocardium, forms the apex of the heart.
Venous and Lymphatic Drainage
- The heart drains via the coronary sinus and anterior cardiac veins into the right atrium.
- Smallest cardiac veins contribute to collateral circulation; lymphatic drainage occurs via subepicardial lymphatic plexus.
Conducting System of the Heart
- Comprises cardiac muscle cells and specialized fibers coordinating the cardiac cycle.
- SA node acts as the pacemaker, initiating impulses at 70 per minute.
- AV node integrates impulses from the atrium and initiates contraction coordination.
Cardiac Cycle Overview
- The cycle includes diastole (ventricular filling) and systole (ventricular emptying).
- Initial diastole starts with valve closure, followed by atrioventricular valve opening and atrial contraction.
- Systole is characterized by closure of atrioventricular valves and opening of aortic and pulmonary valves for blood ejection.
Middle Mediastinum
- Boundaries: The space between the two pleural sacs, containing the heart, great vessels, and trachea.
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Contents:
- Heart
- Pericardium
- Great vessels (aorta, superior vena cava, pulmonary trunk, pulmonary veins)
- Trachea
- Vagus nerves
- Phrenic nerves
- Thoracic duct
- Lymph nodes
Pericardium
-
Anatomical features: A double-walled sac surrounding the heart, composed of fibrous and serous layers.
- Fibrous pericardium: Outermost layer, tough and fibrous, protects the heart and anchors it.
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Serous pericardium: Inner layer, composed of a single epithelial layer, forming two layers:
- Parietal layer: Lines the internal surface of the fibrous pericardium.
- Visceral layer: Lines the external surface of the heart, forming the epicardium.
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Sinuses: Spaces formed by the reflections of the serous pericardium onto the great vessels.
- Transverse pericardial sinus: Posterior to the ascending aorta and pulmonary trunk, anterior to the SVC, superior to the left atrium.
- Oblique pericardial sinus: Posterior to the left atrium, surrounding the pulmonary veins.
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Blood Supply:
- Arterial supply: Pericardiacophrenic artery, smaller contributions from internal thoracic, musculophrenic, bronchial, esophageal, superior phrenic arteries, and coronary arteries (visceral layer only).
- Venous drainage: Pericardiacophrenic veins, internal thoracic, and superior phrenic veins.
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Innervation:
- Phrenic nerve: Primary source of sensory fibers, responsible for referred pain to the skin of the ipsilateral supraclavicular region of the shoulder or lateral neck area (C3-C5 dermatome).
- Vagus nerve: Function uncertain.
- Sympathetic trunks: Vasomotor.
Heart
-
External Anatomy:
-
Layers:
- Epicardium: Visceral layer of the serous pericardium.
- Myocardium: Cardiac muscle.
- Endocardium: Endothelium and subendothelial connective tissue, covers the valves.
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Borders:
- Right: Right atrium, extending between SVC/IVC.
- Inferior: Sharp edge formed by the right ventricle with a small portion of the left ventricle.
- Left: Obtuse margin formed by the left ventricle and left auricle.
- Superior: Right and left atria and auricles.
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Surfaces:
- Anterior: Sternocostal surface, mainly right ventricle, some right atrium and some left ventricle.
- Right: Faces the right lung, consists of the right atrium.
- Inferior: Diaphragmatic surface, mainly left ventricle, faces inferiorly, rests on the diaphragm, separated from the base of the heart by the coronary sinus and extends to the apex.
- Superior: Right and left atria and auricles.
- Left: Pulmonary surface, faces the left lung, mainly left ventricle.
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Sulci: Depressions on the heart surface, marking the borders of the chambers.
- Coronary sulcus: Separates the atria from the ventricles, contains right coronary artery, small cardiac vein, coronary sinus, and circumflex branch of the left coronary artery.
- Interventricular sulci: Separate the two ventricles, containing great cardiac vein (anterior) and posterior interventricular artery and middle cardiac vein (posterior).
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Layers:
Internal Anatomy
-
Right Atrium:
- Receives deoxygenated blood from the superior and inferior vena cava and coronary sinus.
- Contains the SA node (pacemaker of the heart).
- Has a smooth wall and pectinate muscles (in the right auricle).
-
Right ventricle:
- Pumps deoxygenated blood to the lungs.
- Has a rough internal surface with trabeculae carneae, papillary muscles, and chordae tendineae.
- Contains the tricuspid valve and pulmonary valve.
-
Left Atrium:
- Receives oxygenated blood from the lungs through the pulmonary veins.
- Has a smooth wall.
-
Left Ventricle:
- Pumps oxygenated blood to the body.
- Contains the mitral valve and aortic valve.
- Has thicker walls than the right ventricle.
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Cardiac Skeleton:
- Fibrous rings surrounding the valves, providing structural support and separating the atria from the ventricles.
- Provides electrical insulation between the atria and ventricles.
Coronary Circulation
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Arteries:
- Right Coronary Artery: Supplies the right atrium, right ventricle, part of the left ventricle, and the posterior portion of the interventricular septum.
- Left Coronary Artery: Supplies the left atrium, left ventricle, and anterior portion of the interventricular septum.
- Main Branches: Anterior interventricular artery, circumflex artery, marginal branch.
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Veins:
- Great Cardiac Vein: Drains the anterior interventricular sulcus.
- Middle Cardiac Vein: Drains the posterior interventricular sulcus.
- Small Cardiac Vein: Drains the right margin of the heart.
- Coronary Sinus: Collects blood from the cardiac veins and empties into the right atrium.
Cardiac Conduction System
- Specialized tissue responsible for initiating and coordinating heartbeats.
-
Components:
- Sinoatrial (SA) node: Pacemaker of the heart, located in the right atrium.
- Atrioventricular (AV) node: Delays the impulse to allow the atria to contract fully.
- Atrioventricular bundle (bundle of His): Transmits the impulse to the ventricles.
- Right and left bundle branches: Conduct the impulse to the right and left ventricles.
- Purkinje fibers: Distribute the impulse throughout the ventricular myocardium.
Innervation of the Heart
-
Autonomic nervous system regulates heart rate and force of contraction.
- Sympathetic: Increases heart rate and force of contraction.
- Parasympathetic: Decreases heart rate.
- Cardiac Plexus: Network of nerves located anterior to the bifurcation of the trachea, posterior to the ascending aorta, superior to the bifurcation of the pulmonary trunk.
- Visceral afferents: Carry sensory information from the heart to the central nervous system.
Clinical Application
- Pericarditis: Inflammation of the pericardium, causing chest pain and a pericardial friction rub.
- Pericardial effusion: Fluid accumulation in the pericardial sac, can cause heart compression.
- Cardiomegaly: Enlarged heart, can be caused by various conditions.
- Hemopericardium: Blood collection in the pericardial sac, can be life-threatening.
- Pericardiocentesis: Procedure to drain fluid from the pericardial sac.
- Pulmonary Stenosis: Narrowing of the pulmonary valve, obstructing blood flow from the right ventricle to the lungs.
- Thrombi/Emboli: Blood clots in the heart chambers, can travel to other parts of the body.
- Ventricular Septal Defects: Holes in the interventricular septum, allowing blood to flow between the ventricles.
- Heart Valve Diseases: Can lead to regurgitation or stenosis of the valves, affecting blood flow.
- Aortic insufficiency: Leakage of blood back into the left ventricle from the aorta, causing a heart murmur.
- Myocardial Infarction: Heart attack, caused by blockage of a coronary artery, damaging the cardiac muscle.
- Referred Cardiac Pain: Pain originating in the heart, but perceived in other areas of the body (e.g., left arm, jaw).
- Auscultatory areas of the heart: Areas on the chest where heart sounds can be best heard, not necessarily the actual location of the valves.
-
Great vessels:
- Pulmonary trunk: Originates from the right ventricle and splits into left and right pulmonary arteries to carry deoxygenated blood to the lungs.
- Ascending aorta: Arises from the left ventricle and carries oxygenated blood to the body.
Middle Mediastinum
- Located in the inferior mediastinum, between the transverse thoracic plane and diaphragm
- Contains the pericardium, heart, roots of great vessels, arch of the azygos vein, main bronchi, and phrenic nerves with pericardiacophrenic vessels
- Levels of viscera change based on patient positioning (supine vs standing) due to gravity
Pericardium
- Two layers: fibrous and serous pericardium
-
Fibrous pericardium:
- Outer layer of dense connective tissue
- Attached to the diaphragm's central tendon
- Fuses with the great vessels' tunica adventitia
- Anteriorly connected to the sternum by sternopericardial ligaments
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Serous pericardium:
- Single epithelial layer with two layers - parietal and visceral
- Parietal layer: lines the fibrous pericardium's inner surface
- Visceral layer: lines the external surface of the heart, known as the epicardium
Pericardial Cavity
- Potential space between the parietal and visceral layers of the serous pericardium
- Contains serous fluid for heart movement within the sac
Pericardial Sinuses
- Created by reflections of the serous pericardium onto the great vessels
- Transverse pericardial sinus: posterior to ascending aorta and pulmonary trunk, anterior to SVC, superior to the left atrium
- Oblique pericardial sinus: posterior to the left atrium, surrounds the pulmonary veins
Pericardium Vessels and Nerves
-
Arterial supply:
- Pericardiacophrenic artery
- Smaller contributions from internal thoracic, musculophrenic, bronchial, esophageal, superior phrenic arteries, and coronary arteries (for visceral layer only)
- Venous drainage: Pericardiacophrenic veins, entering the azygos system, internal thoracic, and superior phrenic veins
-
Innervation:
- Phrenic nerves: primary source of sensory fibers, referred pain to the ipsilateral supraclavicular region of the shoulder or lateral neck
- Vagus nerve: function uncertain
- Sympathetic trunks: vasomotor
Clinical Significance of the Pericardium
- Surgical procedures involving the heart utilize clamps and ligatures around the aorta/pulmonary trunk and tubes for coronary bypass grafts
- Pericarditis: inflammation of the pericardium, leading to chest pain and pericardial friction rub; must be distinguished from myocardial infarction
Heart - External Anatomy
-
Layers:
- Epicardium (visceral layer of serous pericardium)
- Myocardium (heart muscle)
- Endocardium (inner lining)
- Anatomical position: apex points inferiorly and to the left, base lies superiorly and to the right
-
Borders:
- Right border: right atrium
- Inferior border: right ventricle
- Left border: left ventricle
- Superior/posterior border: left atrium and great vessels
-
Surfaces:
- Anterior surface: right ventricle, left ventricle (small portion)
- Inferior surface: right ventricle, left ventricle
- Left surface: left ventricle
- Right surface: right atrium
- Posterior surface: left atrium, left ventricle
- Diaphragmatic surface: mostly right ventricle, some left ventricle
Heart - Internal Anatomy
-
Right atrium: receives blood from SVC, IVC (body) and coronary sinus (heart walls)
- Auricle: muscular pouch, increases atrium's capacity
- Sulcus terminalis cordis: vertical groove separating two spaces of the atrium, indicated by crista terminalis
- Sinus venarum: smooth, thin-walled, posterior to the crista, where SVC, IVC, and coronary sinus drain
- Pectinate muscles: rough, muscular wall anterior to the crista
-
Openings:
- SVC: upper posterior portion, level of right 3rd costal cartilage
- IVC: lower posterior portion, level of 5th costal cartilage
- Coronary sinus: between right AV orifice and IVC orifice
- Interatrial septum: contains fossa ovalis, important for fetal circulation
-
Right ventricle: receives blood from the right atrium through the right AV orifice
- Tricuspid valve: closes during ventricular contraction
- Pulmonary valve: opens facing forward and medially
- Papillary muscles: attach to chordae tendineae, prevent valve cusps from prolapsing into the atrium
- Conus arteriosus (infundibulum): smooth, funnel-shaped region leading to the pulmonary valve
-
Left atrium: receives blood from four pulmonary veins
- Posterior half: smooth walls, receives pulmonary veins
- Auricle: muscular, anterior half, no distinct separation
- Interatrial septum: anterior wall, contains the valve of foramen ovale
-
Left ventricle: most of the heart base, longer than right ventricle with thickest myocardium
- Mitral valve: closes during ventricular contraction
- Aortic valve: opens facing upward and slightly to the right
- Papillary muscles: attach to chordae tendineae, prevent mitral valve prolapse into the atrium
- Trabeculae carneae: muscular ridges
- Moderator band: muscular band extending from the interventricular septum to the anterior papillary muscle
- Forms apex of heart
Clinical Significance of Heart Chambers
- Atrial septal defect (ASD): congenital defect, can result in left-to-right blood shunt, increasing the size of the right atrium and ventricle
- Pulmonary stenosis: valve cusps fuse, narrowing of the valve or conus arteriosus, restricting right ventricular outflow
- Thrombi: can form in the left atrium, detaching to become emboli (mobile clots) that can occlude arteries
Cardiac Skeleton
- Fibrous rings surrounding the heart valves and the aorta and pulmonary trunks
- Supports the valves and prevents them from overstretching
- Serves as an electrical insulator, separating the atria and ventricles, allowing for controlled electrical conduction
- Supports the myocardial wall and prevents dilation
Coronary Vasculature
-
Arterial blood supply: left and right coronary arteries
- Left coronary artery: branches into the anterior interventricular artery and the left circumflex artery
- Right coronary artery: branches into the right marginal artery and the posterior interventricular artery
-
Venous drainage:
- Great cardiac vein: drains most of the left ventricle
- Middle cardiac vein: drains the posterior interventricular septum
- Small cardiac vein: drains the right ventricle and right atrium
- Coronary sinus: receives blood from the great, middle, and small cardiac veins
- Anterior cardiac veins: directly drain into the right atrium
- Lymphatic drainage: Lymphatic vessels follow the coronary arteries and veins.
Clinical Significance of Coronary Vasculature
- Myocardial infarction: blockage of a coronary artery leading to death of heart tissue
Conducting System of the Heart
- Composed of specialized cardiac muscle cells that generate electrical impulses.
- Responsible for regulating the heart's rhythm and coordinating contractions
- Controls the heart rate and ensures that the atria contract before the ventricles
-
Components:
- Sinoatrial (SA) node (pacemaker): generates impulses
- Atrioventricular (AV) node: delays impulses
- Atrioventricular bundle (bundle of His): conducts impulses to the ventricles
- Right and left bundle branches: conduct impulses to the right and left ventricles
- Purkinje fibers: distribute impulses to the ventricular myocardium
Clinical Significance of the Conducting System
- Arrhythmias: abnormal heart rhythms, caused by disorders of the conducting system
- Heart blocks: interruption in the flow of electrical impulses through the conducting system
- Pacemakers: can be implanted to regulate the heart rhythm
Innervation of the Heart
- Parasympathetic innervation (vagus nerve): slows the heart rate
- Sympathetic innervation: increases the heart rate and force of contraction
- Sensory fibers: convey pain signals to the central nervous system, contributing to referred pain
Clinical Significance of Heart Innervation
- Dysautonomia: dysfunction of the autonomic nervous system affecting heart rate regulation
- Cardiac pain: resulting from ischemia or inflammation affecting the heart muscle
Additional Clinical Notes
- Pericardial effusion: accumulation of fluid in the pericardial cavity, can compress the heart
- Cardiomegaly: enlargement of the heart
- Hemopericardium: blood in the pericardial cavity
- Pericardiocentesis: procedure to drain fluid from the pericardial cavity
- Ventricular septal defects (VSDs): holes in the interventricular septum
- Heart valve diseases: conditions affecting the heart valves, such as stenosis, insufficiency, or prolapse
- Aortic insufficiency: leakage of blood back into the left ventricle from the aorta
- Referred pain: pain experienced in areas of the body away from the source of pain
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This quiz explores the structure and function of the serous pericardium, including its parietal and visceral layers. Learn about the pericardial cavity and the role of serous fluid in facilitating heart movement. Test your understanding of the key concepts related to cardiac anatomy.
