Cardiovascular system Surface Anatomy By Dr. Nabil Khouri MD, MSc, P.hD

Thoracic landmarks The angle of Louis marks the site of the bifurcation of the trachea into the right and left main bronchi and corresponds with the upper border of the atria of the heart.

Apex And Borders Location The Apex of the heart: In the left 5th inter-costal space at mid-clavicular line (~ 9 cm from the midline). Superior border: From the INF border of the left 2nd costal cartilage, ~ 1 cm from the sternum, to the SUP border of the right 3rd costal cartilage, ~ 1 cm from the sternum. Right border: From the SUP border of the right 3rd costal cartilage, ~ 1 cm from the sternum, to the right 6th costal cartilage ~ 1 cm from the sternum. Left border: From the INF border of the left 2nd costal cartilage, ~ 1 cm from the sternum, to the apex. Inferior border: From the apex to the right 6th costal cartilage ~ 1 cm from the sternum.

Borders of the heart 1 Inf. border of the 2nd CC 2 3 Sup. border of the 3rd CC The 7th CC 5th intercostals space 2 3 4 1 6 5 7

Cardiac sounds “Ascoltation” 5th IC LT 2nd IC Lower Lt Sternal border 4th inter-costal space Rt 2nd IC Cardiac sounds “Ascoltation” The sounds associated with each heart valve best heard with a stethoscope? 1. Mitral: 5th left inter-costal space Mid-clavicular line 2. Tricuspid: 4th left inter-costal space 3. Pulmonary: Lower left sternal border at the 2nd inter-costal space 4. Aortic: Right upper sternal border 2nd intercostal space

Simi lunar valve X: The pulmonary orifice is located in the upper angle of the third left sterno-costal articulation; O: The aortic orifice is a little below and medial to pulonary orifice, close to the the third left sterno-costal articulation;

Tricuspid valve O: The right atrioventricular opening  valve is a little lower, opposite the fourth intercostal space of the right side

Bicospidic valve The left atrioventricular opening is opposite the fourth costal cartilage, and rather to the left of the midsternal line

Trachea.—This may be marked out on the back by a line from the spinous process of the sixth cervical to that of the fourth thoracic vertebra where it bifurcates; from its bifurcation the two bronchi are directed downward and lateralward. In front, the point of bifurcation corresponds to the sternal angle. Esophagus.—The extent of the esophagus may be indicated on the back by a line from the sixth cervical to the level of the ninth thoracic spinous process, 2.5 cm. to the left of the middle line.

Aortic arch Lingula Cardiac notch Pulmonary arch Right Atrium Diaphragmatic recess SVC

1. Superior vena cava 2. Inferior vena cava 3. Right atrium (blue) 4. Right ventricle (blue) 5. Left ventricle (red) 6. Aorta 7. Pulmonary trunk

Transverse section at T2 level

T3

Level of the Ascending Aorta T5.

T8 http://www.wesnorman.com/thoraxcrosssections.htm

Can also be used as pressure points to stop bleeding Pulse Points Can also be used as pressure points to stop bleeding

Pulls Common Carotid Artery: lies along the line connecting The st-cl-jointwith a point 2 cm lateral to the Superior border of the thyroid carilage Superficial Temporal Artery

Upper limb Pulse 1 2 Brachial Artery: Medpoint between the two epicodiles 2. Basilic Vein Radial Artery: lateral to the flexor carpi radialis tendon

Arterial Pulse Alternating expansion and recoil of arteries with each heart beat Measured in beats per minute Normal resting pulse: 60 – 100 bpm Taken at pulse points: place where pulse is easily palpated (felt)

Lower Limbs Pulse Femoral Artery Mid inguinal point Popliteal Artery

Pulls Dorsalis Pedis Artery: lateral to the extensor hallucis longus 5cm distal to the extensor retinaculae Posterior Tibial Artery posterior to medial malleolus