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OBJECTIVES
At the end of this session you are expected to:
 List organs of cardio vascular system (CVS)
 Locate the heart anatomically
 Classify the chambers of heart
 Locate neighboring structures of the heart
 Understand blood supply of heart
 Locate great blood vessels anatomically.
 Classify the branches of great vessels
2

Outline
 Pericardium
 Heart
 Orientation of Heart in Thorax
 Chambers of Heart
 Valves
 Arterial supply of the heart
 Venous return of the heart
 Nervous supply of the heart
 Great vessels
3

Thoracic cavity
 Cone shaped
 Has narrow superior aperture (thoracic
inlet)
 Wide inferior aperture (thoracic outlet)
Boundary of inlet
Anterior - Manubrium of sternum
Posterior - Upper part of T1 vertebra
Laterally- Upper border of 1st rib and
cartilage
4

Thoracic cavity……
Boundary of outlet
Anterior - Infra sternal
angle between the costal
margins
Posterior - inferior part of
T12 vertebra
Lateral- costal margin of 7th
- 10th ribs
Inferiorly- Diaphragm
5

Parts of the thoracic cavity
 Thoracic cavity is divided into 3 divisions
Two pleural cavities: Occupy lateral
part and contain the lungs
The mediastinum: The space between
lungs and pleurae
The mediastinum contains
 The pericardium & the heart and
associated great vessels
 Trachea, esophagus, vagus nerves,
phrenic nerves, thymus.
6

Mediastinum
It is cavity located
 Anterior to vertebral column
 Posterior to sternum
 Superior to diaphragmatic
 Between the two lungs
 Divided into superior & inferior
mediastinum by Transverse thoracic
plane
It is cavity located
 Anterior to vertebral column
 Posterior to sternum
 Superior to diaphragmatic
 Between the two lungs
 Divided into superior & inferior
mediastinum by Transverse thoracic
plane
7

Transverse
thoracic
plane
Division of 8

Pericardium
 The pericardium is a double-layered
membranous sac
 It is a fibro serous membrane that covers
the heart and the beginning of its great
vessels
 It is located behind the body of the
sternum and the 2nd to 6th costal cartilages
 In front of the T5–T8 vertebrae.
10

Functions of pericardium
 Surround and protects the heart.
 It confines the heart to its position.
 Allow sufficient freedom of movement
for vigorous and rapid contraction.
 The fibrous pericardium prevents
overstretching of the heart
 Provides protection and anchors the
heart in the mediastinum.
11

Pericardium….CONTD
It consists of two components
 The superficial fibrous pericardium
composed of tough, inelastic, dense
irregular connective.
 Fibrous pericardium is a strong
connective tissue .
 It is the outer layer.
 Continuous with the central tendon of
the diaphragm
12

Serous pericardium
 The deeper serous pericardium is a
thinner, more delicate membrane.
 Forms a double layer around the heart.
1. Parietal layer
2. Visceral layer
13

Pericardial Cavity
 It is a potential space enclosed
between the parietal and visceral
layers of serous pericardium.
 It contains a small quantity of
serous ﬂuid (pericardial fluid).
 This facilitates the sliding of the
two serous layers over each other
during cardiac movements
14

Vasculature and nervous supply
 The arterial supply of the
pericardium is mainly from
pericardiacophrenic artery.
 The venous drainage of the
pericardium is from the:
Pericardiacophrenic veins.
 The nerve supply of the
pericardium is from the:
Phrenic nerves
Vagus nerves 15

The Heart
 The heart is a muscular organ in the
mediastinum.
 A cavity located anterior to the
vertebral column, posterior to the
sternum, above the diaphragmatic
muscle, and between the two lungs
 Its function is to pump blood through
the blood vessels by repeated,
rhythmic contractions.
16

Heart
Orientation of Heart in Thorax
 The heart, slightly larger than a
clenched fist
 The heart is placed obliquely in the
middle mediastinum.
 Approximately two-thirds of the
heart lies to the left and one-third to
the right of the midline.
17

The wall of the heart
 Epicardium - A thin external layer.
 Myocardium –a thick, helical middle
layer composed of most cardiac muscle.
 The walls of the heart consist mostly of
myocardium, especially in the ventricles.
 It is responsible for the pumping action
of the heart
 It is composed of cardiac muscle tissue.
 It makes up approximately 95% of the
heart wall.
18

Endocardium
 A thin internal layer or lining membrane of the heart that also
covers its valves
 It provides a smooth lining for the chambers of the heart and covers
the valves of the heart.
19

Heart
 The pointed apex is formed by the tip of the left ventricle rests on
the diaphragm.
 The base of the heart is opposite the apex and is its posterior aspect.
 It is formed by the atria (of the heart, mostly the left atrium
20

Apex of the heart
 Apex projects forward, downward,
and to the left
 It is formed by infero lateral part of
left ventricle
 Lies posterior to the left 5th
intercostal space in adults, usually
approximately 9 cm from the
median plane
 Is where the sounds of mitral valve
closure are maximal (apex beat).
21

Base of the heart
 Base is opposite to apex & faces in a posterior direction.
 Is formed mainly by the left atrium with a lesser contribution by
the right atrium.
22

Base of the heart
 is Quadrilateral and directed posteriorly
 It consists of:
Left atrium
A small portion of right atrium
SVC and pulmonary veins
Base of the heart
23

Chambers of the Heart
 The heart has four chambers.
 The two superior receiving chambers are
the atria.
 The two inferior pumping chambers are the
ventricles .
 The paired atria receive blood from blood
vessels returning blood to the heart called
veins.
 While the ventricles eject the blood from
the heart into blood vessels called arteries.
24

 Internal partitions divide the heart into four chambers (two atria
and two ventricles) and produce surface or external grooves
referred to as sulci
Coronary sulcus: groove separating atria from ventricles
Anterior and posterior interventricular sulci: divide ventricles
into right and left
Chambers of the heart
25

 The heart functionally consists of two pumps: Left & Right
Pumps:
 Rt pump receives deoxygenated blood from the body & sends it to
the lungs.
 Lt. pump receives oxygenated blood from the lungs and sends it to
the body.
 Each pump consists of an atrium & a ventricle separated by a valve.
 The thin-walled atria receive blood coming into heart, whereas
thick-walled ventricles pump blood out of the heart.
26

Right atrium
 Forms the right border of the heart.
 The right atrium is about 2–3 mm in
average thickness.
 Poorly oxygenated blood returned
from body to the right atrium enters
through :
 Superior vena cava (SVC)
 Inferior Vena cava (IVC)
27

Right atrium
 The SVC opens into the superior part
of the right atrium at the level of the
right 3rd costal cartilage.
 The IVC opens into the inferior part
of the right atrium at the level of the
5th costal cartilage
 Through Right atrio - ventricular (AV)
orifice the right atrium discharges the
poorly oxygenated blood it has
received into right ventricle.
28

Internal view of right atrium
30

RIGHT VENTRICLE
 The right ventricle forms the largest
part of the anterior surface of the
heart.
 Almost the entire inferior border of the
heart
 Located posterior to the body of the
sternum at the level of the 4th and 5th
intercostal spaces.
 Right ventricle receives blood from
the right atrium then pump blood to
the lung through pulmonary artery 31

Internal view of the right ventricle
About 4–5 mm in average thickness.
32

LEFT ATRIUM
 The left atrium forms most of the
base of the heart.
 The pairs of right and left
pulmonary veins enter the smooth-
walled atrium.
 Pulmonary veins entering its
smooth posterior wall deliver
oxygenated blood from lung.
33

LEFT VENTRICLE
 The left ventricle forms the apex of
the heart.
 Average 10–15 mm thickness
 The left ventricle performs more
work than the right ventricle.
 It is longer than Rt ventricle, & has
the thickest layer of myocardium.
 Pump blood to whole body, through
Aorta. (The largest blood vessel in
the body) 34

Internal view of the left
ventricle 35

Cardiac Valves
 Each of the four valves helps ensure the one way flow of blood by
opening to let blood through and then closing to prevent its
backflow.
36

Cardiac Valves
Semilunar Valves
1. Pulmonary valve
 Has 3 cusps (anterior, right, and
left).
 Located at the level of the left 3rd
costal cartilage at the apex of the
right ventricle.
37

Aortic valve
 Has 3 cusps (posterior, right, and left).
 Is located at the apex of the left ventricle at the level of right 3rd
intercostal space.
38

Atrioventricular Valves
1. Tricuspid valve
 Has 3 cusps (anterior, posterior
and septal).
 Located b/n the right atrium
and right ventricle at the level
of the 4th and 5th intercostal
spaces.
39

Mitral (bicuspid)valve
 Has 2 cusps (anterior and posterior).
 Is located b/n left atrium and left ventricle at the level of 4th
costal cartilage
40

Internal view of the left
ventricle 42

Surface Projections of Valves
 Pulmonary: left sternal border
at 3rd sternocoastal joint
 Aortic: near left sternal border
at 3rd intercostal space
 Left AV (mitral): just to left of
midline, 4th sternocoastal joint
 Right AV (tricuspid):
midsternal 4th intercostal
space
43

Auscultatory Areas
44
 Clinicians interest in the surface anatomy of the heart and cardiac
valves results from their need to listen to valve sounds.

Blood vessels of the heart
 The blood vessels of the heart comprise
the coronary arteries and cardiac veins.
Coronary artery
 The coronary arteries, the first branches
of the aorta.
 Right and left coronary arteries supply
heart
 The coronary arteries supply both the
atria and the ventricles.
45

Cardiac veins
 Coronary sinus receives most of
the venous blood from the heart &
empties into right atrium.
 Its tributaries are the small cardiac
vein, middle cardiac vein &
greater cardiac vein.
46

Posterior View
Anterior View
47

GREAT VESSELS
 Great vessels means blood vessels
that arise or drain from or into the
heart.
Includes
Artery
 Aorta
 Pulmonary trunck
Veins
 Superior vena cava
 Inferior vena cava
 Pulmonary veins
48

Aorta
 It is the main arterial trunk of
systemic circulation.
 It arises from Left ventricle
Descriptively it is divided into:
Ascending part
Arch of aorta
Descending thoracic part
Abdominal part.
49

Pulmonary trunk
 Arise from right ventricle
 It divide into Right & Left
pulmonary artery at the level of 3rd
costal cartilage.
50

Pulmonary veins
 Two pulmonary veins leave each lung carrying oxygenated blood
to the left atrium of the heart
Posterior 51

Superior vena cava (SVC)
 It is about 7 cm long and 1.25 cm in
diameter.
 It collects blood from the upper half of
the body and drains it into the right
atrium.
SV
C
52

Inferior vena cava (IVC)
 The IVC is the largest and
widest vein of the body.
 It drains most of the blood
from the body below the
diaphragm into the right
atrium
53

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