anatomy, lecture 7, the heart 2 (slides)
TRANSCRIPT
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Heart (2)Heart (2)
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Superior & InferiorSuperior & Inferior MediastinaMediastina
Pages 111Pages 111--130 Snell 8130 Snell 8thth editionedition
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Innervation to The HeartInnervation to The Heart
Conducting System (initiator)
Autonomic System
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Conducting SystemConducting System
1. Initiates cardiac contraction2. Conducts impulse to ventricles
Sino-Atrial node (SA node)
Atrio-Ventricular node (AV node)
Atrio-Ventricular Bundle (bundle of His)
Rt & Lt bundle branches
Purkinje fibers
(subendocardial plexus)
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SS--A Node (A Node (The PacemakerThe Pacemaker))
Site of contraction initiation
stellate cells (P-cells)
Modified cardiomyocytes
Rt. Atrium:
upper part, anterolateral to SVC
Impulse spreads from SA node
through atrial walls toAV node
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AA--V NodeV Node
The pulse conductor
Lower part ofatrial septum
(above septal cusp)
Conduct pulse to ventricles
through AV bundle
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AV bundle (septum)
Right (moderator) & Left
bundle branches
Purkinje fibers
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Autonomic InnervationAutonomic Innervation
1. Modifies cardiac contraction
To SA & AV nodes
Sympathetic (sympathetic trunk):increase heart rate
increase force of contraction
dilatation of coronary artery
Parasympathetic (vagus nerve):decrease heart rate
reduce force of contraction
constriction of coronary artery
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Arterial SupplyArterial Supply
Coronary arteries:
From ascending aorta & just above the valve
Left (larger):most of Lt ventricle and atrium
anterior 2/3 of ventricular septum , RBB, LBB
Right: rest of the heart
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Left Coronary ArteryLeft Coronary Artery
Larger but shorter
Arises between pulmonary trunk
& Lf. Auricle
Divides to:
1. ant. interventricular a.
2. circumflex a
3. SA nodal (35 - 40%)
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Ant. Interventricular ArteryAnt. Interventricular Artery
LAD: Left AnteriorDescending
Pass in ant. intervent. Groove
turns around the apex
anastomose with post. intervent.
artery
Gives rise to diagonal artery (lateral)
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Circumflex ArteryCircumflex Artery
Pass in left AV groove
winding around the heart in a circle
anastomoses with Rt. coronary posteriorly
Gives rise to left marginal artery
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Angina PectorisAngina Pectoris
Severe chest pain due to O2 shortage to the heart wall
(ischemic heart disease)
Cause:
Partial obstruction or spasm of a coronary artery(arteriosclerosis)
Symptoms:
chest discomfort (pressure, heaviness or tightness)
substernal pain specially after ?
referred pain over the left arm, neck & lower jaw
Complication:
Infarction (death of a part of myocardium)
Angina = G, strangling, Pectoris= L, chest
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Myocardial InfarctionMyocardial Infarction
Interruption of bld. Supply to a part of the heart leading todeath ofheart muscle on that region.
Known as:
Heart Attack
Cause:
complete block of a coronary artery (thrombosis)
Symptoms:
chest pain (as in angina)
dyspnea
Rx.:
Coronary bypass surgery
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Heart ValvesHeart Valves
4 valves:
- 2 semilunar:
Aortic
Pulmonary
- 2 A-V:
Rt A-V:Tricuspid
Lt A-V: Mitral
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Semilunar ValvesSemilunar Valves
Pulmonary:
3 semilunar cusps (2 ant. & 1 post.)
Cusp: folding of endocardium with C.T. inside
Sinus: space behind each cusp
Aortic : similar to pulmonary
2 post. & 1 ant. cusps
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Tricuspid ValveTricuspid Valve
Rt. A-V orifice
3 cusps:
1. ant. 2. post. 3. septal
Attached to papillary m. through
Chordae tendineae
Chordae of each P.M. are connected to adjacent parts of 2 cusps
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Mitral ValveMitral Valve
Left A-V orifice
2 cusps (bicuspid):
Ant. & Post.
Similar attachments &
fxn. as tricuspid valve
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Auscultation of Heart ValvesAuscultation of Heart Valves
((Read Next Slide for Complete DetailsRead Next Slide for Complete Details))
Mitral (M)
Tricuspid (T)
Aortic (A)
Pulmonary (P)
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Auscultation of Heart ValvesAuscultation of Heart Valves
Mitral (M): Lt of sternum, 4th CC
Over the apex
Tricuspid (T): Rt of sternum, 4th intercostal space
Rt of lower end of body of sternum
Aortic (A): Lt of sternum, 3rd intercostal space
Medial end of of 2ndRt intercostal space
Pulmonary (P): medial end of 3rdLtCC
Medial end of of 2ndLt intercostal space
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Posterior MediastinumPosterior Mediastinum
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BoundariesBoundaries
Anterior:
Pericardium & diaphragm
Posterior:
T5 T12
Superior:
??
Inferior:
diaphragm
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ContentsContents
1. Descending thoracic aorta
2. Azygos & hemiazygos veins
3. Thoracic duct
4. Sympathetic trunk
5. Esophagus
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Thoracic AortaThoracic Aorta
Starts left to lower border of T4 body
As it descends shifts to midline
Terminates:
ant. to T12 body (opening ??)
Pass posterior to Lf. Lung root
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BranchesBranches
1. Bronchial a.:trachea, bronchi & lungs
2. Esopahgeal a.
3. Pericardial a.
4. Posterior intercostal a.:
9 pairs (3rd-11th)
5. Subcostal arteries: along the
inferior border of the 12th rib
and goes to the abdomen
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Azygos System of VeinsAzygos System of Veins
(G, unpaired)
Drains Post. thoracoabdominal walls
Exhibits Many variations
3 veins:
Azygos (Rt.)
Inf. hemiazygos (Lf.)
Sup. (accessory) hemiazygos (Lf.)
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Inferior Hemiazygos VeinInferior Hemiazygos Vein
On Left side
From T12J T8
Drains:Lower Lf. Post. intercostal vein
(9th-11th, & subcostal)
At T8:
Turns to Rt. azygos vein
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Accessory HemiazygosAccessory Hemiazygos
On left side (superiorly)
Receives:
4
th
-8
th
Lf. Post. intercostal v.
At T 7:
Turns to Rt. azygos vein
Azygos system provides alternativeAzygos system provides alternative
pathway betweenpathway between
SVC& IVCSVC& IVC
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LymphaticLymphatic
Thoracic DuctThoracic Duct
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Thoracic DuctThoracic Duct
The largest lymph duct in the body
Begins in abdomen as a dilated sac
(cisterna chyli)
Aortic Hiatus
(between aorta & azygos)
Lf. Brachiocephalic Vein
(Jxn: Int. jugular & Subclavian)
Drains lymph from all body except:
Rt. Thorax, Rt. Upper limb, Rt. Head & Neck
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Right Lymphatic DuctRight Lymphatic Duct
Drains:
Rt. Thorax
Rt. Upper Limb
Rt. Head & Neck
Opens:
Junx of Rt. Internal jugular
& Rt. Subclavian
Communicates with thoracic duct
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Thoracic Part of Sympathetic ChainThoracic Part of Sympathetic Chain
Most lat. Structure in mediastinum
Runs on the heads of the ribs
Leaves behind medial arcuate lig.
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EsophagusEsophagus
A tubular structure Begins opposite to C6 as a continuation of thepharynx & ends in the stomach
3 parts:
cervical
thoracic (relations)
abdominal
Pass through sup. & post.
mediastinum
Then through esophageal opening
(T10)
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Thoracic Part RelationsThoracic Part Relations
Anterior:
Trachea & Lf. Recurrent laryngeal n.
(Superior Mediastinum)
Posterior:
Bodies of thoracic vrtebrae
Then
Descending aorta
Thoracic ductAzygos vein
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The Superior MediastinumThe Superior Mediastinum
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BoundariesBoundaries
Sup.: Anatomical thoracic inlet
Inf.: Imaginary line
Ant.: manubrium
Post.: T1-T4
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ContentsContents
1. Brachiocephalic veins & SVC
2. Aortic arch & branches:
brachiocephalic
Lf. C.C.a.
Lf. Subclavian a.
3. Vagus & Phrenic n.
4. Trachea
5. Esophagus
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Brachiocephalic VeinsBrachiocephalic Veins
Formed by union : Int. Jug. v. & Subclavian v.
(at sternoclavicular joints)
Lf.: longer (6 cm)
pass post. to manubrium
ant. to aortic branches
Rt.: 2-3 cm
vertical to right 1
st
cc
Unite behind Rt. 1st cc to form SVC
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Superior Vena Cava (SVC)Superior Vena Cava (SVC)
Starts behind Rt. 1st cc
Ends behind Rt. 3rd cc
Rt. Atrium
Relations:Ant.: Rt. Lung & covering pleura
Post.: root of Rt. Lung
Medial: Ascending aorta
Lateral: Rt. Phrenic & Rt. lung
Tributaries:
Azygos Vein
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AortaAorta
4 Parts4 Parts::
1. Ascending Aorta:
lies within fibrous pericardium sup. to Rt. Until Rt. 2nd cc
branches:
Rt & Lt coronary arteries
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Arch ofArch of AortaAorta (sup. mediast)
curved continuation of Ascending aorta
at Rt. 2nd cc
arches upward-backward & to Lf. Side
infero-posterior
Lf. Side of T4 body (sternal angle)
Relations:
Arches over:
Rt. Pulmonary a. & Lf. Main bronchus
Crossed ant.:
Lf. Vagus & phrenic n.
Rt.:Trachea & Esophagus
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Branches of The ArchBranches of The Arch
1. Brachiocephalic a.: (Rt.)
largest branch
S-C jointJ Rt. CC a. & Rt. Subclavian a.
2. Lf. Common Carotid a.:
enters the neck at S-C joint
3. Lf. Subclavian a.:
most post. branchloops over 1st rib J upper limb
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3. Descending Thoracic Aorta:
Discussed previously
4. Abdominal Aorta:
starts at T12- L1
ends by dividing into:
Rt. & Lf. common iliac a.
at L4
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Nerves in Mediastinum:Nerves in Mediastinum:
Vagus & PhrenicVagus & Phrenic
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Vagus NerveVagus Nerve
CN X (parasympathetic)
Rt. Vagus:
- Lat. to the trachea
- Medial to azygos
- Post. to root of the Rt. lung
- Join esophagus:esophageal opening (Post.)
Gives Rt. Recurrent laryngeal n. that loops around subclavian a.
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Left VagusLeft Vagus
- Descends between Lf. Cc & Lf.
Subc. arteries
- ant. & Lf. to aortic arch
Lf. Recureent laryngeal n.
- Post. to lung root
- Join esophagus:
esophageal opening (ant.)
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Phrenic NervePhrenic Nerve
C3, 4, 5
Motor:
Sole motor to diaphragm
Sensory: Sensory to central part of
diaphragm
Pericardium
Parietal pleura (mediastinal &
diaphragmatic)
Peritoneum (diaphragmatic)
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Rt. PhrenicRt. Phrenic
Descends lat. to
brachiocephalic & SVC
Ant. to root of Rt. Lung
Rt. Side of pericardium
Rt. to IVC:
caval opening
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Left PhrenicLeft Phrenic
Enters Lf. To subclavian a.
Lat. To vagus n (X)
Ant. to root of Lf. Lung
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TracheaTracheaFibrocartilaginous tube
(C6-sternal angle)
In deep inspiration it reaches thelevel of?
U-shaped bars ofhyaline catilage
& smooth muscle (trachialis)
Rt. bronchus:
Wider, shorter & more vertical
Lf. Bronchus:Narrower, longer & more horizontal
Relations of Lf. bronchus?Inf. To aortic arch, ant. To esophagus
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Tracheal RelationsTracheal Relations
Anterior:Lf. Brachiocephalic v. & manubrium
Posterior:
esophagus & recurrent laryngeal n.
Right:Rt. Vagus n. & Azygos v. (just inf.)
Left:Aortic arch, Lf. CC & Subclav. A & Lf. Vagus n.
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