|
Arteries
|
| Artery |
Source |
Branches |
Supply |
Notes |
| aorta, ascending (TG4-21A, TG4-22A, Practical) |
left ventricle of heart |
left & right coronary aa., continues as aortic arch |
heart, entire body |
(Greek, aorta = to lift) |
| atrioventricular nodal (TG4-22B) |
right coronary near the point where it becomes the posterior interventricular
a. |
|
atrioventricular node & surrounding myocardium |
located at junction of coronary sulcus & posterior interventricular sulcus |
| circumflex (TG4-23A, Practical1, Practical2) |
left coronary |
marginal br., possibly posterior artery of left ventricle |
posterior surface of left ventricle |
(Latin, circum = around + flexs = to bend) |
| coronary, left (N216,N219,TG4-22A,TG4-22B,TG4-23A, Practical1, Practical2) |
ascending aorta |
anterior interventricular & circumflex brs. |
left ventricle, left atrium, anterosuperior two-thirds of interventricular septum |
(Latin, coronary = something that is "crown-like", i.e., goes around in a loop) |
| coronary, right (N216,N218,TG4-22A,TG4-22B,TG4-23A, Practical) |
ascending aorta |
sinuatrial nodal, right marginal, posterior interventricular, atrioventricular nodal brs. |
right ventricle, right atrium, inferior third of interventricular septum |
right coronary a. usually provides the posterior interventricular a. (Latin, coronary = something that is "crown-like", i.e., goes around in a loop) |
| septal (TG4-22A, TG4-22B) |
posterior interventricular (Practical) |
|
interventricular septum |
|
| sinuatrial nodal (TG4-22A, TG4-23A, TG4-23B, Practical) |
right coronary |
|
sinuatrial node & surrounding myocardium |
important artery to locate during cardiac surgical procedures |
Veins
|
| Vein |
Tributaries |
Drains Into |
Region Drained |
Notes |
| cardiac, anterior (TG4-24A. TG4-24B) |
|
right atrium |
anterior surface of right ventricle |
bridge the right coronary a. |
| cardiac, great (TG4-24A. TG4-24B, Practical1, Practical2) |
ventricular vv., left marginal |
unites with oblique v. of left atrium to form coronary sinus |
heart near anterior interventricular sulcus |
|
| cardiac, middle (TG4-24C. TG4-24D, Practical1, Practical2, Practical3) |
ventricular vv. |
coronary sinus (TG4-21B. TG4-24C, TG4-24D) |
heart near posterior interventricular sulcus |
|
| cardiac, small (TG4-24C. TG4-24D) |
|
coronary sinus |
heart near inferior vena cava & right coronary sulcus |
|
| cardiac, smallest |
|
directly into heart chambers |
myocardium |
also known as: Thebesian vv.; least cardiac vv.; venae cordis minimae |
| coronary sinus(TG4-24C. TG4-24D, Practical 1, Practical 2) |
formed by union of great cardiac v. & oblique v. of left atrium; tributaries: middle cardiac, small cardiac vv. |
right atrium |
heart except anterior cardiac vv. & venae cordis minimae |
opening into right atrium is guarded by an imperfect valve, (Latin, coronary = something that is "crown-like", i.e., goes around in a loop) |
| pulmonary (TG4-23A. TG4-24A) |
segmental pulmonary vv. |
left atrium |
lungs |
carries oxygenated blood to heart for distribution to body |
| left posterior ventricular (TG4-24C. TG4-24D) |
ventricular vv. |
coronary sinus |
heart near posterior interventricular sulcus |
|
| oblique, of left atrium (TG4-24C. TG4-24D) |
|
unites with great cardiac v. to form coronary sinus |
left auricle & adjacent portion of left atrium |
|
Viscera/Fascia
|
| Organ |
Location/Description |
Notes |
| heart (TG4-19. TG4-20, Practical) |
located within middle mediastinum within pericardial sac, nearly surrounded by pericardial cavity |
|
| coronary sulcus (TG4-21B) |
groove separating atria from ventricles |
coronary sinus, circumflex a., & right coronary a. lie in coronary sulcus, (coronary = something that is "crown-like", i.e., goes around in a loop) |
| endocardium(N221) |
a thin internal layer or lining membrane of the heart that also covers its valves |
|
| myocardium (N221) |
a thick middle layer composed of cardiac muscle |
|
| epicardium |
a thin external layer (mesothelium) formed by the visceral layer of serous pericardium |
|
| epicardial fat (N212,N214) |
loose connective tissue in the epicardial (outer) space |
|
| anulus fibrosus (N222) |
thick collagenous rings surrounding the four orifices of the valves of the heart |
(Latin, anulus = ring) |
| aortic vestibule |
superoanterior part of the left ventricle |
leads to the aortic orifice |
| apex (TG4-19, TG4-21A, TG4-22A, Practical) |
tip of left ventricle |
located 3" left of midline at level of 5th intercostal space (Latin, apex = tip) |
| atrium, right (TG4-27B, Practical) |
forms the right margin of the heart |
receives blood from the superior vena cava, inferior vena cava & coronary sinus |
| atrium, left (TG4-27B, Practical) |
located on the posterior aspect of the heart |
receives blood from the pulmonary vv. |
| auricle (TG4-25C, Practical1, Practical2) |
projects anteriorly from the atrium |
one on each atrium, they lie beside aorta & pulmonary trunk (Latin, auricula = little ear; the auricle of the atrium is shaped like a little ear) |
| base (TG4-21A, TG4-21B) |
superior aspect of heart |
where aorta, pulmonary trunk & superior vena cava enter the heart |
| interventricular septum (TG4-25C, TG4-27B, Practical) |
strong, obliquely placed partition between the left and right ventricles |
has membranous and muscular parts |
| interventricular sulcus, anterior (TG4-25B) |
groove between ventricles on anterior surface of heart |
anterior interventricular a. & great cardiac v. lie within sulcus (Latin/Greek, holkos (sulcus) = furrow) |
| interventricular sulcus, posterior |
groove between ventricles on diaphragmatic surface of heart |
posterior interventricular a. & middle cardiac v. lie within sulcus (Latin/Greek, holkos (sulcus) = furrow) |
| ligamentum arteriosum (TG4-36B, TG4-37B, Practical1, Practical2) |
remnant of ductus arteriosus; connects
left pulmonary a. near origin with undersurface of aortic arch |
left recurrent laryngeal n. passes beneath it |
| pericardial sinus, oblique (TG4-20) |
recess of pericardial cavity located behind left atrium of heart |
serous pericardium reflects on inferior vena cava & pulmonary vv. (Latin, sinus = fold, hollow) |
| pericardial sinus, transverse (TG4-20) |
recess of pericardial cavity located behind aorta & pulmonary trunk and anterior to superior vena cava |
(Latin, sinus = fold, hollow) |
| pericardium, fibrous (TG4-20, Practical) |
forms pericardial sac attached to central tendon of diaphragm; fuses superiorly to adventitia of great vessels; contains pericardial cavity & heart; lined by parietal layer of serous pericardium |
defines outermost boundary of middle mediastinum |
| pericardium, parietal serous (TG4-25A) |
serous lining of pericardial cavity on inner surface of fibrous pericardium (pericardial sac) |
reflects onto heart at great vessels |
| pericardium, visceral serous (TG4-25A) |
serous lining of pericardial cavity on surface of heart; reflects at inferior vena cava & pulmonary vv. to form oblique pericardial sinus |
also known as: epicardium |
| sulcus terminalis (TG4-21B) |
groove on right atrium marking crista terminalis, which is seen within the atrium |
(Latin/Greek, holkos (sulcus) = furrow) |
| ventricle, right (TG4-21A) |
|
features moderator band and 3 papillary mm.; pumps blood into pulmonary trunk |
| ventricle, left (TG4-21A) |
|
features only 2 papillary mm., pumps blood into ascending aorta |
| chordae tendineae (TG4-25B) |
thin connective tissue cords that attach atrioventricular valve cusps to papillary mm. |
(Latin, chordae = cord + tendere = to stretch) |
| crista terminalis (TG4-25A, Practical) |
ridge of cardiac muscle separating smooth sinus venarum posteriorly from rough wall of primitive atrium anterioly |
sinuatrial node lies within superior end of crista terminalis (Latin, crista = crest) |
| atrioventricular bundle (TG4-28A) |
part of conduction system of heart; passes through right fibrous trigone, below membranous part of interventricular septum |
divides into right & left branches to supply ventricles |
| atrioventricular node (TG4-28A) |
part of conduction system of heart; located in wall of right atrium above ostium of coronary sinus & septal cusp of tricuspid valve |
|
| atrioventricular valve, left (TG4-27A) |
between the left atrium and left ventricle |
also known as: mitral or bicuspid valve |
| atrioventricular valve, right (TG4-27A) |
between the right atrium and right ventricle |
also known as: tricuspid valve |
| fossa ovalis (TG4-25A) |
depression in left wall of right atrium |
remnant of foramen ovale connecting right & left atria in the fetus (Latin, fossa = ditch + ovale = oval) |
| limbus fossa ovalis (TG4-25A, Practical) |
ridge around the fossa ovalis in right atrium |
its limbus is located on the interatrial septal wall (Latin, limbus = border + fossa = ditch + ovale = oval) |
| mitral valve (TG4-26A, TG4-26B) |
between left atrium and left ventricle |
also known as: bicuspid or left atrioventricular valve; possesses anterior & posterior cusps (Latin, mitra = a coif or turban, shaped like a bishop's miter, as are the two leaflets of the bicuspid or mitral valve of the heart) |
| moderator band (Practical) |
|
also known as: septomarginal trabecula |
| papillary muscles (TG4-27B, Practical) |
attach to cusps of atrioventricular valves via chordae tendineae; right: anterior, posterior & septal; left: anterior & posterior |
(Latin, papilla = nipple) |
| pectinate muscles (TG4-25A) |
located near auricles in walls of both atria; more pronounced in right atrium |
(Latin, pecten = comb) |
| pulmonary conus |
smooth area of right ventricle below pulmonary trunk |
pulmonary part of the conus arteriosus |
| semilunar valves (Practical) |
located in base of pulmonary trunk & ascending aorta; free margin of cusps called lunula, dense nodule located at midpoint of free margin |
pulmonary valve has anterior, left & right cusps; aortic valve has right, left & posterior cusps (Latin, semis = half + luna = moon, the cusps of semilunar valves are shaped like a half moon) |
| septomarginal trabecula (TG4-25C) |
ridge of cardiac muscle stretching from interventricular septum to anterior papillary m. in right ventricle; contains part of right branch of atrioventricular bundle |
also known as: moderator band |
| sinuatrial node (TG4-25B) |
located within crista terminalis near superior vena cava |
"pacemaker" of heart |
| trabeculae carnae (TG4-25C) |
ridges of cardiac muscle within both ventricles |
(Latin, trabeculae = little beam, carnae = meaty) |
| tricuspid valve (TG4-25C) |
|
also known as: right atrioventricular valve; possesses anterior, posterior & septal cusps |
| valve of the inferior vena cava |
right atrium |
not a true valve, but an embryological remnant - it exists to help shunt IVC blood into foramen ovale |
| valve of the coronary sinus |
right atrium |
not a functional valve, but an embryological remnant |
Nerves
|
| Nerve |
Source |
Branches |
Motor |
Sensory |
Notes |
| cardiac |
vagus, cervical sympathetic trunk |
|
heart (parasympathetic: decrease rate & force of contraction; sympathetic: increase rate & force of contraction); bronchial tree & lungs via pulmonary pleuxs |
heart, bronchial tree & lungs |
vagus has 2 (superior & inferior) cervical cardiac brs. & 1 or more thoracic br.; cervical sympathetic trunk usually gives 3 (superior, middle & inferior) cardiac brs. |
| cardiac plexus(TG4-45, TG4-46) |
cardiac brs. of vagus & cervical sympathetic trunk; thoracic visceral nn. |
continuous with coronary & pulmonary plexuses |
moderate heart muscle (parasympathetic decreases rate & force of contraction; sympathetic increases rate & force of contraction); vascular smooth muscle of heart & lungs (sympathetic); smooth muscle & mucous glands of bronchial tree (parasympathetic) |
pain from heart and lungs; thoracic visceral nn. carry pain from the heart to the upper thoracic spinal cord segments resulting in pain referred to the left upper limb in the T1 and T2 dermatomes |
(Latin, plexus = to braid, a network of nerves, blood vessels, or lymphatic vessels) |
| pulmonary plexus (TG5-40, TG5-41, Practical) |
continuous with cardiac plexus, thoracic visceral nn., pulmonary brs. of vagus |
|
smooth muscle & glands of bronchial tree (parasympathetic); vascular smooth muscle of lungs (sympathetic) |
|
located along pulmonary vessels & primary bronchi in root of lung (Latin, plexus = to braid, a network of nerves, blood vessels, or lymphatic vessels) |
| vagus (TG4-19, Practical) |
medulla: dorsal motor nucleus (preganglionic parasympathetic) and nucleus ambiguus; superior and inferior ganglia |
auricular br., pharyngeal br., superior laryngeal, superior & inferior cervical cardiac brs., recurrent laryngeal, thoracic cardiac brs., brs. to pulmonary plexus, esophageal plexus, anterior & posterior vagal trunks |
intrinsic muscles of larynx, pharynx (except stylopharyngeus), & palate (except tensor veli palatini); preganglionic processes synapse in small ganglia within or near viscera of thorax and abdomen; postganglionic processes from these ganglia supply smooth muscles of respiratory tree & gut (proximal to splenic flexure), heart or are secretomotor to mucous glands of larynx, respiratory tree, pharynx & gut, digestive glands |
skin of external auditory meatus; viscera of head, neck, thorax & abdomen proximal to splenic flexure; taste to epiglottis |
also known as: CN X, 10th cranial nerve; passes through jugular foramen; (Latin, vagus = wanderer, so called because of its wide distribution to the body cavities) |
Clinical Terms
|
| Term |
Definition |
| deltopectoral triangle |
a triangle in the upper chest region that is bounded medially by the clavicle, superiorly by the deltoid m., and inferiorly by the pectoralis major m.; the deltopectoral triangle is pierced by the cephalic vein on its course from the upper limb to join the axillary vein in the axilla |
| precordium |
a rectangular area of body wall over the heart and the lower part of the thorax |
| auscultation |
the act of listening for sounds within the body, chiefly for ascertaining the condition of the lungs, heart, pleura, abdomen and other organs and for the detection of pregnancy |
| atherosclerosis |
the progressive narrowing and hardening of the arteries over time; known to occur to some degree with aging, but other risk factors that accelerate this process have been identified, including: high cholesterol, high blood pressure, smoking, diabetes and family history for atherosclerotic disease |
| coronary bypass (CABG) |
a surgical procedure which involves replacing diseased (narrowed) coronary arteries with
veins obtained from the patient's lower extremities or the patient's internal thoracic arteries
(which have longer periods of patency than veins). During this procedure the patient is placed
on a heart bypass machine (heart-lung machine) to allow the surgeon adequate time to
perform surgery on the resting (non-beating, ice-chilled) heart; this procedure has proven to
extend the lives of individuals with coronary artery disease and improve the quality of life;
recovery in the hospital is approximately 7-10 days |
| myocardial infarct (MI) |
a term used to describe irreversible injury to heart muscle; common symptoms include
substernal, crushing chest pain (which patients typically describe as a feeling of intense
pressure) that may radiate to the jaw or arms; chest pains may be associated with
nausea, vomiting, sweating, and shortness of breath; also known as a heart attack |
| left heart dominance |
dominance in the heart is determined by the source of the posterior interventricular artery. In a right dominant heart (85%), the posterior interventricular is a branch of the right coronary artery. In a left dominant heart (15%), the circumflex branch of the left coronary artery supplies the posterior interventricular. In a left dominant heart, the entire interventricular septum is supplied by branches of the left coronary artery - the most frequently blocked coronary artery. |
| ventricular hypertrophy |
increase in the cellular size of ventricular myocardial cells resulting in gross enlargement. It
should be noted that hypertrophy is the increase in cell size, whereas hyperplasia is the
increase in cell number. |
| septal defects |
a hole in the interatrial septum (the wall between the atria) is called an atrial septal defect
(also known as an ASD); A ventricular septal defect (VSD) usually affects the upper,
membranous portion of the interventricular septum (wall between the ventricles) and is the
most common congenital cardiac defect (26% of all congenital cardiac lesions). |
| coarctation of aorta |
a congenital heart defect that results in the narrowing of the lumen of the aorta; the narrowing
occurs most often just distal to the origin of the left subclavian artery; coarctation occurs in
approximately 7% of patients with congenital heart disease and is twice as common in males;
surgical correction is most often required; symptoms include headaches, dizziness, fainting,
nosebleeds, increased blood pressure in upper extremities, diminished pulses in lower
extremities and muscle cramps in legs with activity; some individuals may be asymptomatic. |
| patent foramen ovale |
an inherited condition where there is nonclosure of the foramen ovale at birth; usually asymptomatic until the third or fourth decades of life, symptoms include exertional shortness of breath, fatigue, and palpitations (Latin, patent = to lie open + foramen = an aperture + ovale = oval) |
| patent ductus arteriosus |
a condition where the normal channel between the pulmonary artery and the aorta fails to close at birth; in normal fetal circulation, the blood bypasses the pulmonary circuit since oxygen and nutrients are acquired through the placenta; after birth, this channel normally closes in response to ventilation of the lungs; those who are affected may demonstrate poor growth, shortness of breath and rapid respiratory rate; diagnosis is via echocardiogram and treatment involves the use of indomethacin, a non-steroidal anti-inflammatory (NSAID) which decreases prostaglandin synthesis to stimulate ductus arteriosus closure; surgical ligation will be required in those cases unresponsive to medical management (Latin, patent = to lie open) |
| cardiac tamponade |
interference with venous return of blood to the heart due to an extensive accumulation of fluid in the pericardium (pericardial effusion); tamponade may occur as a complication of dissecting thoracic aneurysm, pericarditis, renal failure, acute myocardial infarction, hypothyroidism, autoimmune disease (for example lupus), chest trauma or a malignancy; fluid in the pericardial sac is demonstrated by echocardiogram; treatment involves the emergent removal of the fluid; this may be accomplished by a needle aspiration technique or emergency surgery (pericardial window) |
| aortic stenosis |
narrowing of the orifice of the aortic valve or of the supravalvular or subvalvular regions (Greek, stenosis = narrowing) |
| mitral stenosis |
a congenital or acquired heart valve abnormality that involves the narrowing and ineffective opening of the mitral valve (Greek, stenosis = narrowing) |
| mitral valve regurgitation |
the backflow of blood from the left ventricle to the left atrium due to a defective mitral valve
|
| cardiac angiography |
radiographic technique that allows visualization of the heart vessels after injection of a radio-opaque contrast material |
| ischemia |
a decrease in the oxygen delivery to a tissue, often due to an obstructed artery or decreased blood flow (Greek, ischo = to keep back + hemia = blood) |
| murmur |
a finding that can be indicative of heart disease. Murmurs can result from abnormalities in the heart or vessels that lead to turbulent flow |
| cardiac enzymes |
when an area of the myocardium becomes infarcted and undergoes necrosis, cell lysis leads to the release of various cardiac enzymes whose levels can be used to diagnose a myocardial infarction |
| nitroglycerin |
used as a vasodilator, especially in angina pectoris |
| defibrillation |
to arrest the fibrillation of heart muscle by applying an electrical shock across the chest that results in restoration of a normal heart rhythm |
| heparin |
an anticoagulant that works by inhibiting the action of thrombin on fibrinogen, two proteins
of the clotting cascade |
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