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THE PERICARDIUM AND
HEART
DR. NAGAWA EDITH
OBJECTIVES
• pericardium
• Anatomical borders
• Surfaces
• Chambers
• Great vessels
• Blood supply
• Clinical significance
THE PERICARDIUM
• It is a fibrous membrane that covers the heart and great vessels
• Fibrous
• Serous- visceral and Parietal
• Btn the visceral and parietal serous layers is the pericardial cavity
Pericardial sinuses
• The oblique pericardial sinus is a blind ending passageway located on
the posterior surface of the heart.
• The transverse pericardial sinus is found superiorly on the heart. It
can be used in coronary artery bypass grafting –
THE HEART
• The heart is a muscular pump in the body responsible for perfusion of
the entire body.
• Its structural and functional character is vital in assessment and
management of clinical manifestations and pathologies
• It has surfaces, borders, chambers with a rich vascular supply
• The heart is pyramidal shaped with an anteroinferior apex and a
posterior base.
• This is located in the middle mediastinum in a pericardial sac with
phrenic nerves on both sides of the sac
surfaces
• Anterior (or sternocostal) – Right ventricle & a small part of the left
ventricle divided by the anterior interventricular sulcus
• Posterior (or base) – Left atrium separated from the inferior surface
by the posterior coronary sulcus
• Inferior (or diaphragmatic) – Left and right ventricles separated by the
posterior interventricular sulcus
• Right pulmonary – Right atrium.
• Left pulmonary – Left ventricle.
Borders
• Separating the surfaces of the heart are its borders. There are four
main borders of the heart:
• Right border – Right atrium
• Inferior border – Left ventricle and right ventricle
• Left border – Left ventricle (and some of the left atrium)
• Superior border – Right and left atrium and the great vessels
sulci
• The coronary sulcus (or atrioventricular groove) runs transversely
around the heart – it represents the wall dividing the atria from the
ventricles. The sulcus contains important vasculature such as the right
coronary artery.
• The anterior and posterior interventricular sulci can be found running
vertically on their respective sides of the heart.
Chambers
• The heart has 4 chambers responsible for systemic and pulmonary
circulation
• The right atrium
• The right atrium receives deoxygenated blood from the superior and
inferior vena cavae, and from the coronary veins. It pumps this blood
through the right atrioventricular orifice (guarded by the tricuspid
valve) into the right ventricle.
attached is the auricle (right atrial appendage)
• It is divided into 2 parts of different embryological origin by muscular
ridge called the crista terminalis :
• Sinus venarum – located posterior to the crista terminalis. This part
receives blood from the superior and inferior vena cavae. It has
smooth walls and is derived from the embryonic sinus venosus.
• Atrium proper – located anterior to the crista terminalis, and includes
the right auricle. It is derived from the primitive atrium, and has
rough, muscular walls formed by pectinate muscles.
• Left Atrium
• The left atrium receives oxygenated blood from the four pulmonary veins,
and pumps it through the left atrioventricular orifice (guarded by the
mitral valve) into the left ventricle. Has an extending left auricle.
• Has 2 embryological parts
• Inflow portion – receives blood from the pulmonary veins. Its internal
surface is smooth and it is derived from the pulmonary veins themselves.
• Outflow portion – located anteriorly, and includes the left auricle. It is
lined by pectinate muscles, and is derived from the embryonic atrium.
Interatrial septum
• The interatrial septum is a solid muscular wall that separates the right
and left atria.
• The septal wall in the right atrium is marked by a small oval-shaped
depression called the fossa ovalis. This is the remnant of the foramen
ovale in the fetal heart, which allows right to left shunting of blood to
bypass the lungs and closes once the newborn takes its first breath.
ventricles
• Right ventricle
• The right ventricle receives deoxygenated blood from the right
atrium, and pumps it through the pulmonary orifice (guarded by the
pulmonary valve) into the pulmonary artery
• The right ventricle can be divided into an inflow and outflow portion,
which are separated by the supraventricular crest.
Inflow portion has muscular elevations called trabeculae carnae—
grouped as ridges, bridges ( moderator band) and papillary muscles
connected to tricuspid valves via the chordea tendinea
Outflow Portion (Conus arteriosus)
The outflow portion (leading to the pulmonary artery) is located in the
superior aspect of the ventricle with smooth walls. It is derived from
the embryonic bulbus cordis.
• Left ventricle
• The left ventricle receives oxygenated blood from the left atrium, and
pumps it through the aortic orifice (guarded by the aortic valve) into
the aorta.
• Can be divided into an inflow portion and an outflow portion.
• Inflow portion-lined by trabeculae carneae.There are two papillary
muscles present which attach to the cusps of the mitral valve.
• Outflow- Known as aortic vestibule. It is smooth-walled with no
trabeculae carneae and is a derivative of the embryonic bulbus cordis.
Interventricular septum
• The interventricular septum separates the two ventricles, and is
composed of a superior membranous part and an inferior muscular
part.
• The muscular part forms the majority of the septum and is the same
thickness as the left ventricular wall. The membranous part is thinner,
and part of the fibrous skeleton of the heart.
The heart wall
• 3 major layers: the endocardium, myocardium, and epicardium
• The endocardium lines the cavities and valves
• The subendocardial layer lies between, and joins, the endocardium and the
myocardium. It consists of a layer of loose fibrous tissue, containing
thevessels and nerves of the conducting system of the heart. The purkinje
fibres are located in this layer.
• As the subendocardial layer houses the conducting system of the heart,
damage to this layer can result in various arrhythmias.
• The myocardium is composed of cardiac muscle and is an involuntary striated
muscle. The myocardium is responsible for contractions of the heart.
• Epicardium
• The epicardium is the outermost layer of the heart, formed by the
visceral layer of the pericardium. It is composed of connective tissue
and fat. The connective tissue secretes a small amount of lubricating
fluid into the pericardial cavity.
• is lined by on its outer surface by simple squamous epithelial cells
The conduction system
• Sinoatrial node-pacemaker cells), and is located in the upper wall of
the right atrium, at the entry of the superior vena cava.
• Atrioventricular nodelocated within the atrioventricular septum, near
the opening of the coronary sinus.-
• Atrioventricular bundle (bundle of His)-
• Purkinje fibers- located in the subendocardial surface of the
ventricular walls, and are able to rapidly transmit cardiac action
potentials from the atrioventricular bundle to the myocardium of the
ventricles.
Great vessels
• Aorta (Brachiocephalic trunk,Left common carotid artery, Left
subclavian artery)
• pulmonary arteries and veins, and
• the superior and inferior vena cavae.
Valves
• Atriventricular valves- tricuspid between the right atrium and right

ventricle and bicuspid/mitral btn the left atrium and left ventricle
• Semilunar valves- aortic and pulmonary valves
Blood supply
• Right and left coronary sinuses- arise from the the aortic sinuses
The right coronary branches
-marginal, posterior interventricular,
The left coronary branches
- Anterior interventricular, circumflex
veins
• The great cardiac veinruns with the anterior interventricular and
circumflex branches of the left coronary artery. The small
• cardiac vein runs with the marginal branch of the right coronary
artery.. The
• middle cardiac vein accompanies the posterior interventricular artery.
Clinical significance
• Transverse sinuses- identified during coronary artery bypass grafting
• Atrial septal defects
• Disorders of the myocardium- myocarditis, myocardial infarctions,
angina- stable and non stable
• Endocarditis
• Pericardial infusions
• Pacemakers for bradycardia
• Aortic dissection and aneurysms
• Aortic stenosis
Tetralogy of fallot
auscultation
References
• Clinically oriented anatomy by snell
• Keith moore
• Cunninghams dissection manual
• Teachmeanatomy.com

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THE PERICARDIUM AND

• Atriventricular valves- tricuspid between the right atrium and right

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