Anatomi Sistem Cardiovascular

Biomedik I

Muhammad Iqbal Basri

Department of Anatomy
Hasanuddin University
Thorax
 Parts and regions of the thorax
Boundaries
 Superiorly－jugular notch,
sternoclavicular joint,
superior border of clavicle,
acromion, spinous
processes of C7
 Inferiorly－xiphoid process,
costal arch, 12th and 11th
ribs, vertebra T12
Regions
 Thoracic wall

 Thoracic cavity
 Landmarks of thorax
 Incisura jugular corresponds
with
 The 2th thoracic vertebra in male,
the 3th thoracic vertebra in female
 Angulus sternalis (Ludovici)
corresponds with
 Connects 2nd costal cartilage
laterally
 The lower border of 4th thoracic
vertebra
 The bifurcation of trachea in the
adult
 The beginning of aortic arch which
ends posteriorly at the same level
 The esophagus is crossed by the
left main bronchus
 Landmarks of thorax
 Processus xiphoideus －
xiphisternal synchondrosis
lies opposite the body of the
9th thoracic vertebra
 Clavicula
 Inferior fossa of clavicle
 Coracoid process
 Ribs and intercostal spaces
 Arcus costalis
 Infrasternal angle
 Xiphocostal angle
 Papillae
 Thoracic wall
Superficial structures
 Skin
 Superficial fascia
 Superficial aa.
 Superficial vv.
 Thoracoepigastric v.
 Lateral thoracic v.
 Superficial nn.
 N. Supraclavicularis
 Anterior and lateral cutaneous
branches of intercostal n.
 Lymphatic drainage of breast
 Into pectoral ln. from lateral and
central parts of breast
 Into apical and supraclavicular ln.
from superior part of breast
 Into parasternal ln. from medial
part of breast
 Into interpectoral ln. from deep
part of breast
 The lymphatic capillaries of breast
form an anastomosing network
which is continuous across the
midline with that of the opposite
side and with that of the abdominal
wall
 Thoracic wall
Deep structures
 Deep fascia
 Superficial layer
 Deep layer—clavipectoral fascia
 Muscles of thorax
 Subclavius
 Pectoralis major
 Pectoralis minor
 Serratus anterior
 Intercostales externi
 Intercostales interni
 Intercostales intimi
 Endothoracic fascia
 Spatium intercostalis

Posterior intercostal v.

Posterior intercostal a.
Intercostal n.

Technique for
thoroacocentesis
(in midaxillary line)
Intercostal nerve block
 Internal thoracic vessels
 a.&v. Thoracalis interna
 Descends into thorax 1.2cm
lateral to edge of sternum
 Ends at the sixth costal
cartilage by dividing
musculophrenic and superior
epigastric arteries
 Ln. parasternalis
The Mediastinum
 The Mediastinum
Concept
 All of organs between the left and
right mediastinal pleurae is called
mediastinum.
 It extends from the sternum in
front to the vertebral column
behind, and from the thoracic inlet
above to the diaphragm below.
 Subdivisions of mediastinum

 Mediatinum superior
 Mediastinum inferior
 Mediastinum anterior
 Mediastinum medius
 Mediastinum posterior
 Left side of mediastnum
Left subclavian a.
Thoracic duct
Left vagus n. Aortic arch
Left recurrent n.
Phrenic n. & Thoracic aorta
pericardiacophrenic a.
Sympathetic trunk
Root of lung

Pericardium

Esophagus Greater splanchnic n

 Right side of mediastnum
Trachea
Right vagus n. Superior vena cava
Arch of azygos v. Phrenic n. &
pericardiacophrenic a.
Azygos v.
Root of lung
Sympathetic trunk

Esophagus Pericardium

Inferior vena cava

Superior mediastinum
 Superior mediastinum
Locating－from inlet of thorax to
plane extending from level of sternal
angle anteriorly to lower border of
T4 vertebra posterioly
Contents
 Superficial layer
 Thymus
 Three veins
 Left brachiocephelic v.

 Right brachiocephelic v.

 Superior vena cava

 Superior mediastinum
Contents
 Middle layer
 Aotic arch and its three
branches
 Phrenic n.
 Vagus n.
 Superior mediastinum

Contents
 Posterior layer
 Trachea
 Esophagus
 Thoracic duct
 Relations of aortic arch
 Anteriorly and to the left
 Pleura
 Lung
 Phrenic n.
 Pericardiacophrenic vessels
 Vagus n.
 Posteriorly and to the right
 Trachea
 Esophagus
 Left recurrent n.
 Thoracic duct
 Deep cardiac plexus
 Relations of aortic arch
 Superiorly
 Its three branches
 Left brachiocephalic v.
 thymus
 Inferiorly
 Pulmonary a.
 Arterial ligament
 Left recurrent n.
 Left principal bronchus
 Superficial cardiac plexus
 Triangle of ductus arteriosus

 Boundaries
 Phrenic n.
 Left vagus n.
 Left pulmonary a.
 Contents
 Arterial ligament
 Left recurrent n.
 Superficial cardiac plexuses
Triangle of ductus arteriosus
Mediastinum inferior
 Inferior mediastinum
Anterior mediastinum
 Location－posterior to body of sternum
and attached costal cartilages, anterior
to heart and pericardium
 Contents
 Fat

 Remnants of thymus gland

 Anterior mediastinal lymph nodes

 Inferior mediastinum
Middle mediastinum
 Location－between anterior
mediastinum and posterior
mediastinum
 Contents
 Heart and pericardium

 Beginning or termination of great

vessels
 Phrenic nerves

 Pericardiacophrenic vessels

 Lymph nodes
 Inferior mediastinum
Posterior mediastinum
 Location－posterior to heart and
pericardium, anterior to vertebrae
T5－T12
 Inferior mediastinum
Posterior mediastinum
 Contents:
 Esophagus
 Vagus n.
 Thoracic aorta
 Azygos system of veins
 Thoracic duct
 Thoracic sympathetic trunk
 Posterior mediastinal lymph nodes
 Relations of esophagus

 Anteriorly
 Trachea
 Bifurcation of trachea
 Left principal branchus
 Left recurrent n.
 Right pulmonary a.
 Anterior esophageal plexus
 Pericardium
 Left atrium
 Diaphragm
 Relations of esophagus

 Posteriorly
 Posterior esophageal plexus
 Thoracic aorta
 Thoracic duct
 Azygos v.
 Hemiazygos v.
 Accessory hemiazygos v.
 Right posterior intercostal v.
 Relations of esophagus
 Left
 Left common carotid a.
 Left subclavian a.
 Aortic arch
 Thoracic aorta
 Superior part of thoracic duct
 Right
 Arch of azygos v.
 Relations of thoracic aorta
 Anteriorly
 Left root of lung
 Pericardium
 Esophagus
 Posterior
 Hemiazygos v.
 Accessory hemiazygos v.
 Right
 Azygos v.
 Thoracic duct
 Left－mediastinal pleura
 Mediastinal spaces
 Retrosternal space
lies beween sternum and endothoracic
fascia
 Pretracheal space
lies within superior mediastinum,
between trachea, bifurcation of
trachea and aortic arch
 Retroesophagus space
lies within superior mediastinum,
beween esophagus and endothoracic
fascia
Anatomi Cor
Position
 Lies within the
pericardium in middle
mediastinum
 Behind the body of
sternum and costal
cartilages 2 to 6
 In front of thoracic
vertebrae 5 to 8
 A third of it lies to the
right of median plan
and 2/3 to the left
External characteristics－a
hollow muscular organ, pyramidal
in shape , somewhat larger than
a closed fist; consists of four
chambers (right and left atria,
right and left ventricles)
 Apex cordis is formed by left
ventricle and is directed
downwards and forwards to the
left. It lies at the level of the fifth
left intercostal space, 1~2cm
medial to the left midclavicular
line (9cm from the midline)
 Basis cordis is formed by the left
atrium and to a small extent by
the right atrium. It faces backward,
upward and to the right
Two surface
 Facies sternocostalis
is formed mainly by the right
atrium and right ventricle,
and a lesser portion of its
left is formed by the left
auricle and ventricle. It is
directed forwards and
upwards
 Facies diaphragmaticus
is formed the ventricles－
chiefly the left ventricle,
directed backwards and
downwards, and rest upon
the central tendon of the
diaphragm
Three borders
 Margo dextra (acutus)
－vertical, is formed
entirely by right atrium
 Margo sinistra (obtusus)
－round, is mainly formed
by the left ventricle and
partly by the left auricle
 Margo inferior－
horizontal, is formed by
the right ventricle and
cardiac apex
Four grooves
 Sulcus coronarius (circular sulcus)
which marks the division between atria
and ventricles, contains the trunks of the
coronary vessels and completely
encircles the heart
 Sulcus interatrialis －separates the two
atria and is hidden by pulmonary trunk
and aorta in front
 Sulcus interventricularis －anterior
and posterior, mark the division between
ventricles (which separates the RV from
the LV), the two grooves extend from the
base of the ventricular potion to a notch
called: the incisura apex cordis
Crux atrioventricularis －a junction of the
posterior interventricular groove and
coronary sulcus
Chambers of the heart
Atrium dextra (RA)

Three inlets
 Orificium vena cava superior －returns
blood to the heart from the upper half of
the body
 Orifice of inferior vena cava －returns
blood to the heart from the lower half of the
body
 Orificium sinus coronarius －returns
blood to the heart from the cardiac muscle
One outlet
－orificium atrioventricularis dextra
 Crista terminalis
－vertical ridge thatjfrom superior
vena cave to inferior vena cave
 Sulcus terminalis
－groove on exterior of heart that
corresponds to crista terminalis
Two parts－separated externally by
sulcus terminalis and internally by
the crista terminalis
 Atrium proprius
 In front of the ridge
 Pectinate muscles in wall
 Auricula dextra－a small
conical muscular pouch, projects
to the left from the root of
superior vena cava, pectinate
muscles in wall
 Sinus venarum cavarum
 Lies posterior to the ridge
 Smooth walls
 Fossa ovalis －an oval
depression, a remnant of the
fetal foramen ovale, on the lower
part of interatrial septum, the
most common location of atrial
septal defects (ASD)
 Limbus fossae ovalis
– prominent margin of fossa
ovalis
Ventriculus dextra (RV)
Receives deoxygenated blood
from right atrium through right
atrioventricular orifice
 One inlet－ orificium
artrioventricularis dextra
 One outlet－orificium truncus
pulmonalis
 Two parts－divided by the crista
supraventricularis, a muscular
ridge between right atrioventricular
orifice and orifice of pulmonary
trunk
Inflow tract－rough walls
 Trabecula carnae
－irregularly arranged bundles
of myocardium
 Trabecula septomarginal
－extends from interventricular
septum to base of anterior
papillary muscle, contains right
bundle branch
 Musculus papillaris
－conical-shaped , anterior,
posterior and septal
Out flow tract
 Conus arteriosus
cone-shaped, smooth area
leading upward to orifice of
pulmonary trunk
 Pumps blood through
pulmonary orifice to pulmonary
trunk
Atrium sinistra (LA)

 Auricula sinistra－projecting to
the right, pectinate muscles in wall
 Four inlets－four orificium
pulmonalis open through the
posterior wall
 One outlet－orificium
atrioventricular sinistra, blood
leaves through left atrioventricular
orifice to left ventricle
Ventriculus sinistra (LV)
 Has wall three times thicker
than that of right ventricle
 One inlet－orificium
atrioventricular sinistra
 One outlet－orificium aorticus
 Two parts－divided by anterior
cusps of mitral valve
 Inflow tract－rough walls
 Outflow tract – vestibulum
aorticus , smooth area leading to
aortic orifice
Valves
Valvula tricuspidalis
 Guards right atrioventricular
orifice
 Three triangular cusps: anterior,
posterior and septal, the base of
cusps are attached to fibrous ring
surrounding the atrioventricular
orifice
 Chorda tendineae －fine, white,
connective tissue cords, attach
margin of cusps to musculus
papillaris
Valvula mitralis
 Guards left atrioventricular
orifice
 Two triangular cusps－anterior
and posterior with
commissural cusps between
them (posteromedial and
anterolateral commissures)
 Similar structures to those of
right
Similar functions for right and left atriventricular valves
 Open during diastole to allow blood to enter ventricles from
atria
 Closed during systole to prevent regurgitation of blood into
atria
Valvula truncus
pulmonalis
 Guards the orifice of
pulmonary trunk
 Has three semilunar cusps –
each with free border that
has central nodulus
valvula semilunaris
Valvula aorticus
 Guards the aortic orifice
 Three semilunar cusps (right,
left and post)
 Three aortic sinuses – bulges
in aortic wall at level of valve
that correspond to cusps
 Right－contains opening
of right coronary artery
 Left－contains opening of
left coronary artery
 Posterior－no opening
Similar functions for
pulmonary and aortic
valves
 Opening during systole,
with cusps pressed
toward wall of vessel as
blood is forced upward
 Closed during diastole
 Ventricular pressure drops
in diastole
 Floating together of valve
cusps, with free borders
meeting, thus closing the
valve
Structure of the heart
Walls of heart
 Endocardium－inner coat
of the heart wall, and
continuous with the valve
flaps
 Myocardium
 Arranged spirally

 Attached to fibrous rings

surrouding the four
orifices of heart
 Epicardium －serous
membrane (visceral
pericardium)
Septum interatrialis
 Located between right and
left atria
 Contains fossa ovalis and
limbus
Septum interventricularis
 Located between right and
left ventricles
 Has upper membranous
part
 Has thick lower muscular
part
Fibrous skeleton
 Fibrous rings that surround
the atrioventricular,
pulmonary, and aortic
orifices
 Left and right fibrous trigons
Conduction system of heart
 Consists of specialized
myocardial cells
Nodus Sinoatrialis
(SA node)
 Called the pacemaker cell
(P cell)
 Located at the junction of
right atrium and superior
vena cava, upper part of
the sulcus terminalis,
under the epicardium
Nodus atrioventricularis
(AV node)
 Located in the lower part of interatrial
septum just above the orifice of
coronary sinus, under the
endocardium
 Lower part related to membranous
part of interventricular septum
Atrioventricular
bundle/fasciculus (AV bundle)
 Passes forward through right fibrous
trigon to reach inferior border of
membranous part
 Divides into right and left bundle
branches at upper border of muscular
part of interventricular septum
Right and left bundle
branches
 Right bundle branch－passes
down on right side of
interventricular septum to reach
the septomarginal trabecular and
into the base of anterior papillary
muscle. Here it becomes
continuous with the fibers of
Purkinje fibres
 Left bundle branch－passes down
on left side of interventricular
septum beneath the endocardium.
It usually divides into two branches,
which eventually become
continuous with the Purkinje fibers
Purkinje fibers
－continuous with myocardium
Arterial supply
Arteri coronaria sinistra
 Arises from left aortic sinus
 Runs between pulmonary trunk and left
auricle into coronary sulcus
 Branches
 Ramus interventricularis anterior
－travels downward in anterior
interventricular groove around inferior
margin of heart to posterior interventricular
groove
 Ramus circumflexus－travels to left in
coronary sulcus to posterior aspect
 Distribution－supplies left atrium and
ventricle, lesser portion of anterior wall of
right ventricle, and anterior 2/3 of
interventricular septum
Arteri coronaria dextra
 Arises from the right aortic sinus
 Runs forward between right auricle
and pulmonary trunk into coronary
sulcus
 Branches
 Ramus marginalis dextra －travels
along inferior bord
 Ramus interventricularis posteror
－travels downward in posterior
interventricular groove, it
anastomosises near the apex with
the anteriorinterventricular branch of
the left coronary artery
 Distribution: supplies right atrium
and ventricle, posterior 1/3 of
interventricular septum, posterior wall
of left ventricle, the sinuatrial node
and atrioventricular node
Venous drainage
Sinus coronarius
 Located in posterior part
of coronary sinus
 Carries most of venous
blood from myocardium to
right atrium
 Tributaries
 Vena cordis magna
 Vena cordis media
 Vena cordis parva
 Vena cordis anterior
－3~4 small vessels,
drain into right atrium
 Smallest cardiac veins
－drain into all chambers,
mainly atria
Pericardium
Pericardium fibrosa
 Attached to central tendon of
diaphragm inferiorly
 Blends with outer coat of great
vessels superiorly
Pericardium serosa
 Visceral pericardium (epicardium)
 Parietal pericardium
Cavum pericardii
 Potential space between visceral
and parietal pericardium
 Contains film of pericardium fluid
Sinus pericardium
 Sinus pericardium transversus －posterior to ascending
aorta and pulmonary trunk, anterior to superior vena cava
and left atrium.
 Sinus pericardium oblique－cul-de-sac , posterior to heart,
bounded by pulmonary veins on either side
Surface markings of heart
 Right border－corresponds to
a line running from the upper
border of right third costal
cartilage ±1.2cm from the
margin of sternum, downwards
to sixth sternocostal joint
 Apex－in the fifth left
intercostal space 7~9cm from
the midline
 Left border－represented by a
line running from apex
upwards and medially to a
point on lower border of left
second costal cartilage
±1.2cm from sternal margin
 Lower border－represented
by a line joint the lower end of
right border to apex
Dissection of the heart