cardiac anatomysinoemedicalassociation.org/ap2/cardio/cardioanatomyx.pdfmediastinum • superior –...

Cardiac Anatomyy

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MediastinumMediastinum

MediastinumMediastinum

• SuperiorAb l b t t l l d– Above plane between sternal angle and inferior border of T4 vertebral body

I f i• Inferior– Anterior– Middle– Posterior

PericardiumPericardium

• PericardiumPericardium– Fibrous

Serous– Serous• Parietal layer• Visceral layerVisceral layer

• Phrenic NervesPhrenic Nerves

Serous Pericardium (Parietal Layer)

Fibrous Pericardium

Serous Pericardium (Visceral Layer)

(Epicardium)

Subepicardium

Myocardium

Subendocardium

PericardiumPericardium

Innervation of HeartInnervation of Heart

• Sympathetic Nervous SystemSympathetic Nervous System– T1-T4

• “Cardiac accelerators”• Cardiac accelerators– Stellate ganglia (cervicothoracic ganglia) and

middle cervical gangliamiddle cervical ganglia– Distributed throughout the heart

Innervation of HeartInnervation of Heart

• ParasympatheticParasympathetic– Originate in medulla oblongata

Vagus nerves– Vagus nerves– Much innervation to SA and AV nodes

Little innervation to ventricles– Little innervation to ventricles

Conduction SystemConduction System• Sinoatrial Node

– Interatrial conduction pathways (SA to LA)– Internodal conduction pathways (SA to AV)

• Atrioventricular Node– Bundle of His

Bundle Branches• Bundle Branches– Left Bundle Branch

• Left anterior division• Left posterior division

– Right Bundle Branch

AV ConductionAV Conduction

• AV node is situated on the right side ofAV node is situated on the right side of interatrial septum near the ostium of the coronary sinuscoronary sinus

Conduction SystemConduction System

SA Node

AnteriorInternodal

*

MiddleInternodal

*

PosteriorInternodal

*

Anterior interatrial myocardial band

Right Atrial

* Pathway* Pathway* Pathway* (Bachmann’s Bundle)

Left Atrium

Tracts*

Left AtriumAN Region N Region

NH RegionAV Node

Bundle of His

fRight Bundle Branch

Left Bundle Branch

Anterior Division

Posterior Division

Cardiac ChambersCardiac Chambers

• Right AtriumRight Atrium• Left Atrium

Ri ht V t i l• Right Ventricle• Left Ventricle

Right Atrium

• Vena Cavae– Superior– Inferior

• Eustachian valve• Crista terminalis (divides right atrium)

– Right atrial appendage (right auricle)• Trabeculated

– Smooth portion of atrium around vena cavae• Coronary Sinus (venous drainage of heart)• Fossa Ovalis

– Remnant of foramen ovale• Tricuspid Valve

Base and Diaphragmatic Surfaces of Heart

Right VentricleRight Ventricle

• Coarsely trabeculated inletCoarsely trabeculated inlet

S th tl t• Smooth outlet– Right ventricular outflow tract (RVOT)

VentriclesVentricles

Left AtriumLeft Atrium

• Pulmonary veins (4)Pulmonary veins (4)• Left atrial appendage

Left VentricleLeft Ventricle

• Thick WallThick Wall• Anterior and Posterior Papillary Muscles

VentriclesVentricles

Cardiac AnatomyCardiac Anatomy

Aortic ValveAortic Valve

• Separates left ventricle and aortaSeparates left ventricle and aorta• Located between (and on the same plane

as) the Mitral and Tricuspid valvesas) the Mitral and Tricuspid valves• Trileaflet (3 leaflets)• Right and Left Main Coronary Arteries

originate in sinuses behind valve leaflets• Sino-tubular junction

Aortic ValveAortic Valve

Cardiac AnatomyCardiac Anatomy

Aortic ValveAortic Valve

Mitral ValveMitral Valve

• Separates Left atrium from Left VentricleSeparates Left atrium from Left Ventricle• Two leaflets

A t i L fl t– Anterior Leaflet• Wide and short

Posterior Leaflet– Posterior Leaflet• Narrow and long

P ill l• Papillary muscles• Chordae tendinae

Mitral ValveMitral Valve

A t iAnterior Leaflet

Posterior LeafletLeaflet

Papillary MusclesPapillary Muscles

Tricuspid ValveTricuspid Valve

• Separates Right atrium from RightSeparates Right atrium from Right ventricle

• 3 Leaflets• 3 Leaflets– Anterior leaflet

P t i l fl t– Posterior leaflet– Septal leaflet

Pulmonary ValvePulmonary Valve

• Separates Right Ventricle from PulmonarySeparates Right Ventricle from Pulmonary artery

• 3 Cusps• 3 Cusps– Sinuses of Valsalva

L t d b hi d th l• Located behind the valve cusps

Coronary ArteriesCoronary Arteries

• Right CoronaryRight Coronary– Dominance: In 85% of individuals the RCA supplies

the posterior descending artery (PDA) • Left Coronary

– Left anterior descending (LAD)• Diagonal

– Left circumflex• Obtuse marginal• Obtuse marginal

– Ramus intermedius (37%)

Epicardial VesselPericardium (Epicardium)

Subepicardium

( p c d u )

p

Myocardium

Subendocardium

Myocardial Segment AnatomyMyocardial Segment Anatomy

Cardiac AnatomyCardiac Anatomy

With Corresponding Echo ViewsEcho Views

The EndThe End