What are the bony landmarks of the heart location?
Sternebrae 1-4 (manubriosternal complex)
Costal cartilages 2-6
T5-T8 (thoracic vertebrae)
What are the layers (and locations) of the pericardium?
Fibrous peridcardium (outside)
Serous pericardium (inside)
What are the two types of serous pericardium and their locations?
Visceral (outside of heart on epicardium)
Parietal (inner lining of fibrous pericardium)
What type of pericardium forms the two sleeves containing the great vessels?
What structure lies between these two sleeves?
Parietal serous pericardium
Transverse pericardial sinus
(Rx: ligatures in bypass)
What is the order of vessels branching from the aorta?
1. Brachiocephalic trunk
2. Left common carotid
3. Left sublcavian
SVC is R & L brachiocephalic veins
What sulcus runs between the RA and RV?
Anterior atrioventricular or coronary sulcus
Where is the coronary sulcus located?
Between the RA and RV.
aka anterior atrioventricular groove
Where is the anterior interventricular sulcus?
Between RV & LV
What is the location of the posterior AAV groove/coronary sulcus?
Delineates where the LV ends and LA begins on the posterior aspect of the heart.
What valve is between the RA and RV?
Where is the tricuspid/AV valve?
Between RA & RV
What is the musculi pectinati?
Ridged muscle on internal anterior wall of RA
What lines the interior anterior wall of the RA?
Musculi pectinati and crista terminalis
What is the sinus venarum?
Smooth lining of the posterior interior wall of the RA
What is the crista terminalis?
At the right border of the heart
End of the musculi pectinati ridges and beginning of sinus venarum (moving anterior to posterior) inside the RA
Venous return of the SVC comes from
head, neck, thorax (except heart), upper limbs
Venous return from the IVC comes from
Everything below diaphragm
abdomen, pelvis, lower limbs
What is the function of the coronary sinus?
Where does it enter?
Venous return from the coronary vessels of the heart
Enters RA next to IVC
What are the names of the vena caval valves?
None. SVC has no valve; IVC is rudimentary
The fossa ovalis is
Remnant depression from foramen ovale in the interatrial septum
Foramen ovale allows bypass of the pulmonary circulation in the developing fetus because the lungs are not oxygenating the blood
Which valves are semilunar?
Aortic and pulmonary
Where are the trabeculae carnae?
Internal surface of the ventricles
They stop just before the entrance to the pulmonary valve, at the infindibulum
The infindibulum is
where the trabeculae carnae of re RV stop before the pulmonary valve
aka conus arteriosus
What are the papillary muscles?
Specialized trabeculae carnae that attach to the cups of the cuspid valves via chordae tendinae
RV: 3 (to tricuspid)
LV: 2 (to bicuspid)
What is unique about the LA relative to the structure of the RA?
All of the walls are smooth, except for the appendage with the 4 openings for each pair of pulmonary veins
What are the two functions of the fibrous skeleton?
1. Anchors the atrial and ventricular muscle masses together while electrically isolating them
2. Provides attachements for the base of each valve cusp (the part not attached to the chordae tendinae)
What is the structure of the fibrous skeleton?
Figure 8/conjoined circles around the AV valves (mitral and tricuspid)
2 coronets around the semilunar valves (aortic and pulmonary)
Do chordae tendinae open valves, or close valves?
Neither. They hold the valve closed to prevent backflow during ventricular contraction (systole) where V pressure exceeds A pressure
What is the structure of the semilunar valves?
BOTH HAVE 3 CUSPS
Base: attached to interior (intima) surface of the aorta and pulmonary vessels; external to this join lies the coronets of the fibrous skeleton
Apices: free flowing in the centre of the vessels; no muscles, chordae tendinae, etc.
Where are the origins of the R & L coronary arteries?
In the aortic sinus at the base of the aorta attaching to the LV; in 2/3 aortic cusps
What type of tissue is the conducting system made of?
The SA node sits
On the crista terminalis (between musculi pectanati and sinus venarum in RA)
Anterior to the SVC
The AV node sits
On the posterior wall of the RA, between the tricuspid (AV) valvue and the coronary sinus
What is the order of the electrical conduction pathway?
Bundle of His (through fibrous skeleton)
R (Ant) & L (Post) bundle branches (interventricular septum)
Purkinje fibres (ventricular walls)
Where does the external nervous innervation come from?
Superficual and deep branches of the cardiac plexus at the base of the heart.
PS from vagus
SS from sympathetic trunks
What does the right coronary artery supply?
Right-side structures, (mostly) anterior:
- descends AAV/coronary sulcus
- turns posteriorly @ inferior border, via AIC/coronary sulcus
- gives off the posterior interventricular branch which anastamoses posteriorly with the anterior interventricular branch of LCA
- the rest continues and anastamoses w/circumflex branch of LCA
What does the left coronary artery supply?
Left-sided structures, (mostly) posterior:
L coronary artery, divides into:
- anterior interventricular branch via AIV groove, turns at inferior border to anastamose with posterior interventricular branch of RCA
- circumflex branch via atrioventricular groove to anastamose w/RCA
What is the blood supply to the SA & AV nodes?
R coronary artery
60% of cases, supplies SA
80-90% of cases, supplies AV