1. HEART, ITS BLOOD SUPPLY & PERICARDIUM
DR. JAMILA - ELmedany

2. OBJECTIVES HEART: Location.
External features( Apex, Base, Surfaces, Borders, Chambers, Valves and Great Vessels).
PERICARDIUM :
Layers :
Fibrous (Attachment , Nerve supply).
Serous ( Parietal & Visceral).
Pericardial sinuses ( Transverse & Oblique).
Coronary arteries:
Origin, Course & Distribution and Branches).
Coronary Sinus :
Origin, Tributaries & Termination.
Veins other than Coronary Sinus.

3. LOCATION OF HEART
It lies in a centrally located partition in the thoracic cavity
Middle Mediastinum
between the two laterally placed Lungs.

4. EXTERNAL FEATURES Three surfaces
It has the shape of a full Pyramid lying on one of its sides.
It has:
Apex
Base
Three surfaces
Sternocostal (Anterior)
Diaphragmatic (Inferior)
Posterior ( Base)

5. CARDIAC CHAMBERS
The heart is divided into FOUR Chambers by Cardiac Septa into:
Right & Left Atria.
Right & Left Ventricles.
The Auricles are the superior part of the atria.
The right atrium and ventricle are anterior to the left atrium and ventricle.

6. CARDIAC SEPTA Anterior & Posterior IV Grooves:
Separate the two ventricles.
Coronary Sulcus: Separates the two atria from the two ventricles.

7. APEX left 5th intercostal space
It is directed downward, forward and to the left.
It is formed by the Left Ventricle
It lies deep to the
left 5th intercostal space
(3.5’’) 0r (8.5 -9) cm from the
midline.
L. Ventricle
Apex

8. BASE It is opposite to the apex and directed posterior.
It is formed Mainly by:
Left atrium.
Right atrium (small portion).
Proximal parts of the Great Veins.

9. STERNOCOSTAL SURFACE It is formed Mainly by: Right ventricle .
Some of the Right Atrium.
Some of the Left Ventricle.

10. DIAPHRAGMATIC SURFACE
It faces inferiorly and rests on the Diaphragm.
The heart rests on this surface.
It is formed Mainly by: Left and Right Ventricles.
Inferior part of Right Atrium.

11. POSTERIOR SURFACE (BASE)
It is formed Mainly by:
Left atrium into which opens the (4) pulmonary veins.

12. BORDERS Right : Right atrium Left : Left Auricle above.
Left Ventricle below.
Lower (Inferior): :
Mainly: Right Ventricle.
Sharing:
Right Atrium .
Apex.

13. RIGHT ATRIUM It receives venous blood through : Superior vena cava.
Inferior vena cava.
Coronary sinus.

14. RIGHT VENTRICLE
The outflow of blood leaves the right ventricle into the Pulmonary Trunk.
It communicates with the pulmonary trunk through the Pulmonary Orifice.
Infundibulum:
It is the upper part of the ventricular cavity near the pulmonary orifice.

15. LEFT ATRIUM It is in front of the esophagus.
Its smooth posterior part receives the openings of
(4) Pulmonary Veins.
The arterial blood leaves it into the left ventricle through the Left Atrioventricular Opening.

16. LEFT VENTRICLE
Its walls are three times thicker than that of the right ventricle.
Its outflow of blood is continuous superiorly with the ascending aorta through the Aortic Opening.

17. ATRIOVENTRICULAR VALVES
Tricupid Valve:
It guards the Right Atrioventricular Orifice.
It consists of Three Cusps.
Mitral (Bicuspid) Valve:
It guards the Left AtrioVentricular orifice.
It consists of Two Cusps.
The cusps are attached to the Papillary muscles of the Ventricular walls by Cordae Tendine.

18. PULMONARY & AORTIC VALVES
They guard the Pulmonary and Aortic Orifices.
Each one consists of Three Semilunar Cusps.
The mouths of the cusps are directed up.
Their sides are attached to the wall of the vessel.
The Right and Left Coronary Arteries originate from the right and left Aortic Sinuses.

19. PERICARDIUM Structure:
It is a Fibroserous membrane that surrounds the heart and the adjacent parts of the large vessels entering and leaving it.
Layers :
It consists of two layers:
Outer Fibrous.
Inner Serous.

20. PERICARDIUM
Site :
It is in the middle mediastenum behind the body of the sternum and the 2nd -6th costal cartilages.
Functions:
It restricts excessive movements of the heart.
It acts as a lubricating container.

21. FIBROUS PERICARDIUM It is a strong flask shaped sac.
Its Base is on the diaphragm.
Its Apex is continuous with the adventitia of the great vessels.

22. ATTACHMENTS The base is attached to: Central Tendon of the Diaphragm.
Anteriorly: Sternum by the Sternopericardial
ligaments.
These attachments keep the heart in its position and limits cardiac distension.

23. SEROUS PERICARDIUM It is two layers : Visceral. Parietal.
The pericardial cavity is between the two.
Parietal layer:
It Lines the fibrous pericardium.
It is Reflected around the roots of the great vessels to be continuous with the visceral layer.
Visceral layer (Epicardium):
It is closely applied to the heart.

24. NERVE SUPPLY Nerves supplying the pericardium are from: Vagus nerve.
Sympathetic trunk.
Phrenic nerves.

25. PERICARDIAL SINUSES
They are recesses of pericardium on the Posterior Surface of the heart.
They are due to the reflection of the (Parietal Layer) of the serous pericardium on the great vessels.

26. PERICARDIAL SINUSES Transverse sinus:
It is between the Aorta , Pulmonary Trunk and Great Veins.
Oblique sinus:
It is on the posterior surface of the Left Atrium.

27. CORONARYARTERIES Right and Left arteries. Arise from:
The initial part of the Ascending Aorta. Immediately above the aortic valve.

28. RIGHT CORONARY On the anterior surface of the heart:
It lies between the right auricle and the pulmonary trunk.
At the inferior border of the heart:
It continues to the inferior surface.

29. BRANCHES (1) Right Conus artery:
To the infundibulum and the upper part of the anterior wall of the right ventricle.
(2) Anterior Ventricular arteries :
To the anterior surface of the right ventricle.
The Marginal artery is the largest branch.

30. BRANCHES (3) Posterior ventricular arteries:
To the diaphragmatic surface of the right ventricle.
(4) Atrial branches:
To the right atrium .
The Artery of the SAN.

31. (5) POSTERIOR IV ARTERY It lies in the posterior IVG. It supplies:
A. The diaphragmatic surface of the right and left ventricles.
B. The posterior part of the IVS septum excluding its apex.
C. Septal branch to the AVN.

32. LEFT CORONARY ARTERY
It descends between the pulmonary trunk and the left auricle.
It enters the AIV groove and divides into its Two Terminal Branches : Anterior IV artery.
Circumflex artery.

33. ANTERIOR IV ARTERY
It descends in the IV groove to the apex of the heart.
2/3 of people:
It Anastomoses with the right coronary in the posterior IV groove.
It gives:
Ventricular branches to both ventricles and the IV septum.
Left (Lateral) diagonal artery

34. BRANCHES OF L.CA (3) Left Marginal:
It supplies the left margin of the left ventricle down to the apex.
(4) Anterior &
Posterior ventricular:
To the left ventricle.
(5) Atrial :
To the left atrium.

35. CORONARY SINUS It drains most of the venous blood of the heart.
It lies in the posterior part of the AV groove.
Origin :
It is the direct continuation of the Great Cardiac Vein.
Tributaries:
(1) Cardiac Veins:
A. Great.
B. Middle.
C. Small.
(2) Oblique vein of left atrium.

36. TERMINATION It opens in: The Right Atrium.
Its opening is to the left of the IVC.

37. VEINS DRAIN OUT CS 1. Anterior cardiac veins:
They open directly into the right atrium.
2. Venae Cordis minime :
Open into the heart chambers.

38. REVISION
1. The left coronary artery bifurcates into the circumflex branch and the:
a. Posterior interventricular.
b. Anterior interventricular.
c. Left marginal.
d. Left ventricular.
2. Structures which can be seen on the anterior surface of the heart include:
a. Right atrium.
b. Right ventricle.
c. Pulmonary veins.
d. Pulmonary trunk.

39. REVISION 3. The right ventricle:
a. Forms most of the inferior surface of the heart.
b. Forms the inferior border of the heart.
c. Has a tricuspid valve made of three cusps.
d. Supplied by both coronary arteries.
4. The tributaries of the coronary sinus are:
a. Venae cordis minime.
b. Middle cardiac vein.
c. Great cardiac vein.
d. Small cardiac vein.

40. REVISION 5. The posterior surface of the heart is mainly formed by:
a. Right atrium.
b. Right ventricle.
c. Left atrium.
d. Left ventricle.
6. The mitral valve guards:
a. Right atrioventricular orifice.
b. Aortic orifice.
c. Left atrioventricular orifice.
d. Pulmonary orifice.

41. REVISION 7. Regarding the pericardium:
a. Its fibrous layer is attached to the diaphragm.
b. The oblique sinus is behind the right atrium.
c. It has a nerve supply from the vagus nerve.
d. The epicardium is the visceral layer of the serous pericardium.
8. The coronary arteries:
a. Arise from the inferior aspect of the aortic arch.
b. Anastomose with each other.
c. Give atrial and ventricular branches.
d. Supply the conducting system of the heart.

42. REVISION 9. The right coronary artery:
a. Lies between the left auricle and the pulmonary trunk.
b. Supplies the right atrium.
c. Gives off a posterior interventricular branch.
d. Takes part in the arterial supply of the SAN.
10. Regarding the heart:
a. The left ventricle forms most of its anterior surface.
b. The right border is formed by the right ventricle.
c. The apex is deep to the left fifth intercostals space.
d. The base is formed mainly by the right atrium.

43. REVISION
11. On the diaphragmatic surface of the heart, the posterior interventricular septum separates:
a. Right ventricle – right atrium.
b. Left ventricle – left atrium.
c. Left atrium – right atrium.
d. Left ventricle – right ventricle.
12. The fibrous pericardium:
a. Separated completely from the sternum.
b. Lined by the visceral pericardium.
c. Receives nerve supply from the phrenic nerves.
d. Forms the transverse and oblique pericardial sinuses.

44. REVISION 13. The coronary sinus empties into: a. Left atrium.
b. Right atrium.
c. Right ventricle.
d. Superior vena cava.
14. The SAN receives its blood supply principally from:
a. Anterior interventricular artery.
b. Circumflex artery.
c. Posterior interventricular artery.
d. Right coronary artery.

45. REVISION 15. The apex of the heart is normally located:
a. At the level of the 5th thoracic vertebra.
b. Deeply to the 3rd intercostals space.
c. Deeply to the 5th intercostals space.
d. At the level of the 5th rib.